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2015 Bruce A. Gibbard Memorial Lecture

Bruce A. Gibbard, M.D. Memorial Lectureship Program
Sponsored by the University of Vermont College of Medicine Department of Psychiatry

Richard Chefetz, M.D.

“Relentless Shame: The Paradoxical Protective Use of Self-Eviscerating Power in the Wake of Interpersonal Trauma”

Friday, March 27, 2015

The Davis Auditorium
UVM Medical Education Center/University of Vermont Medical Center, Burlington

Morning Program:

10:15 – 10:30 A.M.    Vermont Psychiatric Association’s Presentation of the Bruce A. Gibbard, M.D. Award for Clinical Excellence

10:30 – 11:45 A.M.     Bruce A. Gibbard, M.D. Memorial Lecture
(Grand Rounds Workshop # 15-128-30)
Entering a Mind Filled with Relentless Shame: A Frame for Exploration and Engagement in Psychotherapy

12:00 – 1:00 P.M.       Lunch Reception—Davis Auditorium Lobby

Afternoon Program:

1:00 – 3:00 P.M.         Workshop* (Davis Auditorium)
Negativity and Negative Therapeutic Reaction: Negativity as Paradoxical Personal Power

*The Afternoon Workshop is open to Clinicians and Mental Health Professionals only.  Attendance and clinical affiliation will be taken at the door. 

Lecture and Workshop Descriptions:

Morning Lecture
We will explore how there is neither a more pervasive nor more toxic emotional experience than discovering a mind is wrapped in a caul of shame, as if from birth onward. The withering of human potential that shame provokes sometimes creates a paradoxical oasis of misery from which a suffering soul cannot seem to be coaxed. In this exploration, shame will become more visible through an understanding of its physiologic and somatic origins, relevant neurobiology, role in attachment, and context in the organization of a multiple self-state model of mind.

Afternoon Workshop
Using verbal case presentation, PowerPoint, and digital video of material from the long-term treatment of a woman subject to negative therapeutic reaction, we will explore the unique paradoxically life-preserving nature of a person becoming ensconced in negativity and negative therapeutic reaction. Particular attention is given to the dissociative processes active in her treatment.

The workshop uses an “in-the-trenches” approach both to convey clinical knowledge and to bring out the best in ourselves and our patients. The existence of the wish to change while staying the same is a normal human paradox, however it exerts an especially strong force in the treatment of severe disturbances in otherwise talented people. Armed with the knowledge and perspective in this presentation, participants will take home a greater understanding of what needs to be accomplished in these difficult treatments.


Lewis, H. B. (1987). The Role of Shame in Symptom Formation. Hillsdale, N.J.: Lawrence Earlbaum Associates, inc.
Nathanson, D. L. (1992). Shame and Pride: Affect, Sex, and the Birth of the Self. New York: W.W. Norton & Company.
Valenstein, A. F. (1973). On attachment to painful feelings and the negative therapeutic reaction. Psychoanalytic Study of the Child, 28: 365-392.
Wurmser, L. (2000). The Power of the Inner Judge: Psychodynamic Treatment of the Severe Neuroses. Northvale, NJ: Jason Aronson.
Wurmser, L., Jarass, H., Eds. (2013). Nothing Good is Allowed to Stand: An Integrative View of the Negative Therapeutic Reaction. Psychoanalytic Inquiry Book Series. New York: Routledge.

Learning Objectives:
At the conclusion of these presentations participants will be able to:

  1. Describe the difference between the words affect, feeling, and emotion, as well as the clinical utility of distinguishing between them.
  2. Explain the likely sources of negative therapeutic reaction in the treatment of a person with a complex dissociative disorder.
  3. Describe a clinical stance that will slowly erode the use of negativity and the negative therapeutic reaction.
  4. Explain the value of a self-state psychology in working with negativity and the negative therapeutic reaction.

About Our Speaker:

Richard Chefetz, M.D. is a psychiatrist in private practice in Washington, D.C. He was President of the International Society for the Study of Trauma and Dissociation (2002-3), Founder and Chair of their Dissociative Disorders Psychotherapy Training Program, and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is also a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington Center for Psychoanalysis. He is a Certified Consultant at the American Society of Clinical Hypnosis, and is trained in Level I and II EMDR. Dr. Chefetz was editor of Dissociative Disorders: An Expanding Window into the Psychobiology of Mind for the Psychiatric Clinics of North America (March, 2006), “Neuroscientific and Therapeutic Advances in Dissociative Disorders,” in Psychiatric Annals (August, 2005), and “Multimodal Treatment of Complex Dissociative Disorders,” in Psychoanalytic Inquiry (20:2, 2000), as well as numerous journal articles on psychoanalytic perspectives on trauma and dissociation. His recently published book with Norton (2015), in their Interpersonal Neurobiology series, is entitled Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real.

Continuing Education Credits:

The morning lecture (Workshop # 15-128-30) is part of the UVM Department of Psychiatry Grand Rounds Series. Attendees will receive 1.25 AMA PRA Category 1 CreditsTM

The University of Vermont College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Vermont designates this educational activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Afternoon Workshop is not accredited for Category 1 CME Credits. Application has been made for CEU Credits for Psychologists, Social Workers, and Mental Health Counselors.

Registration and Program Fees—WE WELCOME ALL DONATIONS!

The annual Gibbard Lectureship Program is provided at no charge to participants, thanks to donations made to the Bruce A. Gibbard M.D. Lectureship in Psychiatry Fund at the University of Vermont, College of Medicine. Donations to support future programs are needed and very much appreciated. To make a donation and to learn more about the Gibbard Lectureship Fund contact: Allison.Searson@uvm.edu.

Directions to Davis Auditorium:

From the University of Vermont Medical Center Parking Garage Level 2 (orange), enter the Ambulatory Care Center (ACC). Once inside, follow the signs to the Medical Education Center. At the snack kiosk, turn left through the double glass doors. Davis Auditorium is on the right.

Directions to University of Vermont Medical Center Parking Garage:

Map available online at: uvmhealth.org. Click on Locations, click on The University of Vermont Medical Center, Main Campus, 111 Colchester Avenue, Burlington, and a map will appear.

Or, from Google Maps, type in “FAHC Garage”, click on “garage, near FAHC, Burlington, VT”, and follow directions from your location.

Questions? Contact: Debra at debraalopez@comcast.net or

Jean Pieniadz, Ph.D., Bruce A. Gibbard Lectureship Committee Chair, or Committee Members: James Jacobson, M.D., Judith Lewis, M.D., Debra Lopez, M.D., and Gerri Oppedisano, Ph.D.