© 2019 by NOVA EMDR Workshops

kathy steele, mn, cs

A 2-Day Workshop

 

Working With Chronic Shame, Resistance, and Traumatic Memory in Complex PTSD and Dissociative Disorders (With and Without EMDR)

EMDR trained clinicians will learn important modifications which will add to the standard protocol, protecting clients from decompensating, and enabling EMDR to be used with this population. As these techniques can be used with or without EMDR, EMDR training is not required to attend this workshop.

San Diego, CA-  October 17-18, 2020 

Venue to be Announced Soon

About the Workshop

This advanced workshop will focus on several topics that can be particularly challenging in the treatment of complex PTSD and dissociative disorders. We will explore chronic shame in-depth, its physiology and functions, its many manifestations, and practical ways to resolve it, using cognitive, emotional, somatic, and imagery approaches, as well as EMDR when appropriate.

 

Chronic resistance will be discussed as a co-creation of therapist and client and can best be understood as a phobic avoidance of what is perceived to be intolerable. Therapists will learn how to recognize and address resistance step by step without evoking further defense in the client and will learn to recognize their own contributions to resistance. Shame and resistance are essential to address in the context of processing traumatic memory.

 

On the second day, we will focus on special approaches to resolving traumatic memory in dissociative clients, with and without EMDR. One of the unique challenges of approaching dissociated traumatic memories is how to support not only the person as a whole but each dissociative part, in remaining grounded and present. Resourcing each part is important.

 

Specific interventions will be discussed, including hypnotic imagery and other approaches that can be utilized with EMDR when appropriate. Participants will learn how to deal with non-verbal or preverbal memory with somatic approaches. We will also discuss the importance of “bearing witness,” in which memory is shared in relationship as a narrative, rather than always viewed as a therapeutic problem. We will discuss how to determine which approaches might be most helpful to a particular client.

Workshop Objectives

 

Participants will be able to:

  • Describe the functions and physiology of chronic shame in highly traumatized individuals

  • Employ at least five interventions to resolve chronic shame

  • Describe the important functions of resistance in psychotherapy

  • Employ at least five interventions to resolve enduring resistance in dissociative clients

  • Assess which approaches will be most effective for resolving traumatic memory in dissociative clients

  • Utilize somatic interventions, time distortion, and hypnotic imagery to help resolve dissociative traumatic memories

Day 1

 

1. Describe the functions and physiology of chronic shame in highly traumatized individuals.

     a. Evolutionary and social functions of shame

     b. Emotional functions of shame

     c. Physiological of shame

          i. Hyperarousal as an initial reaction

          ii. Hyperarousal as a chronic response

2. Describe the important functions of resistance in psychotherapy.

     a. Protecting the damaged self and preserving the idealized self

     b. Avoiding contact with overwhelming emotions, thoughts, sensations, memories, and dissociative parts

     c. Protecting from the dangers of connection and unbearable loss

3. Identify sociocultural contributions to shame and discuss the impact of shame messaging on the therapist.

     a. Social messages

     b. Cultural and familial shame messages

     c. Religious shame messages

4. Explain the Compass of shame and identify each defense in a clinical example.

     a. Attacking self

     b. Attacking other

     c. Isolation

     d. Avoiding inner experience

5. Employ at least three bottom-up and three top-down interventions to resolve chronic shame.

     a. Top-down approaches

          i. Psychoeducation about shame

          ii. Psychoeducation about animal defense during trauma

          iii. Working with shame schemas and negative cognitions

     b. Bottom-up approaches

          i. Working with the felt sense of shame

          ii. Connecting negative cognitions with sensations of shame

          iii. Activating the nervous systems in hypoarousal in shame

          iv. Imagery techniques for Chronic shame

6. Name three ways therapist can increase their resilience in the face of shame and help clients do the same.

     a. Accepting vulnerability and humanity

     b. Accepting shame as part of the human condition

     c. Safely sharing the experience of shame

     d. Compassion toward your own shame

     e. Improved mentalizing

 

Day 2

 

7. Identify the protective functions of resistance and the trauma-related phobias that underlie much resistance

     a. Resistance as protection

     b. Trauma-related phobias and resistance

          i. Phobia of inner experience

          ii. Phobia of dissociative parts

          iii. Phobia of attachment and attachment loss

          iv. Phobia of traumatic memory

          v. Phobia of adaptive change

8. Distinguish between temporary and enduring characterological resistance and discuss treatment implications

     a. Reluctance: working through fear and shame as resistance

     b. Characterological resistance

          i. Relationship as resistance

          ii. Lack of awareness of resistance

          iii. Ways of being as resistance

          iv. Working with characterological resistance

               1. Managing countertransference

               2. Giving client control

9. Employ at least five interventions to resolve resistance in clients with Complex PTSD and Dissociative Disorders.

     a. Stance of compassionate curiosity

     b. Managing countertransference

     c. Getting consultation

     d. Exploring resistance and its perceived value to the client

     e. Taking small, experimental steps

10. Assess which approaches will be most effective for resolving traumatic memory in dissociative clients.

     a. Determining a rational approach to traumatic memory

     b. Degree of amnesia and inner conflicts as guides to titration

     c. Capacity for client to use imagery and other hypnotic techniques

11. Utilize somatic interventions, time distortion, and hypnotic imagery, and titration techniques to process traumatic memories.

     a. Somatic approaches to resolving traumatic memory (with and without EMDR)

     b. Anchoring clients after the end of the memory as a resource

     c. Titration techniques

          i. Titrating experience

          ii. Titrating time

               1. Use of time contraction

          iii. Pendulation techniques between memory and resource

12. Identify ways to work with dissociative parts in processing traumatic memory in clients with DID or OSDD.

     a. Understanding the impact approaching traumatic memory on the system of the individuals

     b. Including all parts in the work

     c. Working with some parts while containing other parts

     d. Making decisions about whether to work with some or all parts in a traumatic memory

 

 

Schedule

 

Day 1

 

9:00 – 10:30

Introduction

Functions of shame

Shame as part of the human condition

Physiology of shame

The many faces of shame

          Social, cultural, and religious contributions to chronic shame

10:30 – 10:45

BREAK

10:45 – 12:15

What are we ashamed of? Treatment implications

The Compass of Shame: How we defend against shame

“Antidotes” to shame: Pride, competence, compassion, mentalizing, relationship

12:15 – 1:30

LUNCH

1:30 – 3:00

The problem with common approaches to shame

          Talking about shame

          Giving shame “back” to the perpetrator

          “You are not bad” and “You have nothing to be ashamed of”

What really works to reduce chronic shame? Approaches and techniques

          Top-down approaches

Building shame resilience in ourselves and our clients

3:00 – 3:15

BREAK

3:15 – 5:00

What really works to reduce chronic shame?

          Bottom-up approaches

Building shame resilience in ourselves and our clients

Day 2

 

9:00 – 10:30

Introduction

A compassionate approach to resistance

Resistance as protection

Learning to identify and expect resistances early in therapy

          Identifying resistance in assessment

          Identifying resistance in the relationship

Differences between temporary and enduring (characterological) resistance with treatment implications

Understanding trauma-related phobias as resistance

Identifying common conflicts in resistance

10:30 – 10:45

BREAK

 

10:45 – 12:15

Understanding and dealing with resistance between dissociative parts: A systems perspective

Relational challenges in resistance

Strategies to resolve resistance

 

12:15 – 1:30

LUNCH

 

1:30 – 3:00

Issues and controversies in traumatic memory processing

The many approaches to processing traumatic memory

Challenges and strategies in processing traumatic memory in clients with Dissociative Disorders

 

3:00 – 3:15

BREAK

 

3:15 – 5:00

Techniques

          Processing as a relational experience

          How to work with dissociative parts

          Resourcing techniques

          Containment techniques

          Titration techniques

          What is the work after processing a memory?

About the Presenter

Kathy Steele, MN, CS has been in private practice in Atlanta, Georgia for over three decades, and is an Adjunct Faculty at Emory University. Kathy is a Fellow and a past President of the International Society for the Study of Trauma and Dissociation (ISSTD) and is the recipient of a number of awards for her clinical and published works, including the 2010 Lifetime Achievement Award from ISSTD. She has numerous publications in the field of trauma and dissociation, including three books, and frequently lectures internationally on these and related topics.

 

 

 

 

 

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