ABSTRACT
The chapter describes clients who totally dissociate shame. As background, it summarizes how the term dissociation is used, beginning with neurobiology, polyvagal theory, and trauma theory. A psychoanalytic understanding of trauma and dissociation belongs within a long tradition of “making the unconscious conscious.” Contemporary relational psychoanalysts think more about the return of the dissociated than the return of the repressed when they think about achieving more integrated consciousness. The author provides case material related to Dissociative Identity Disorder. Danielian and Gianotti offer a useful Four Quadrant scheme for working with highly dissociative and narcissistic clients who perform “character solutions” for unbearable shame. Relational psychoanalysts such as Donnel Stern attend to the therapists’ side of mutually dissociated enactment in therapy relationships. The convergence of right-brain theory and relational psychoanalytic theory is unambiguous in the Foreword that Schore wrote for Philip Bromberg’s book on working through enactments with relationally traumatized patients. Necessary vertical integration of right-brain dissociation happens through the emotional “nearness” of the analyst.
