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Overcoming Trauma-Related

Shame and Self-Loathing


Janina Fisher, Ph.D.

Copyright 2013
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12/13

Materials Provided By

Janina Fisher, Ph.D. is a licensed clinical psychologist and instructor


at the Trauma Center, founded by Bessel van der Kolk, MD. A
faculty member of the Sensorimotor Psychotherapy Institute,
an EMDR International Association consultant, past president
of the New England Society for the Treatment of Trauma and
Dissociation, and former instructor, Harvard Medical School, Dr.
Fisher lectures nationally and internationally on the integration of
the neurobiological research and new trauma treatment paradigms
into traditional psychotherapies.

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Transforming Shame
and Self-Loathing
in the Treatment of
Trauma
A PESI Webcast
December 9, 2013

Janina Fisher, Ph.D.


f h

Shame and self-loathing create vicious circles for trauma


survivors, inhibiting healthy therapeutic change

Shame acts as a barrier to


resolution in trauma treatment
The persistence of shame responses, even after
years of treatment, poses a barrier to final resolution
of trauma. Full participation in life, pleasure and
spontaneity,
t
it healthy
h lth self-esteem
lf t
are counteracted
t
t d
by recurrent shame states and intrusive thoughts
Shame is not only triggered by criticism, normal
mistakes, and less-than-perfect performance but also
by success, being seen, self-assertion, self-care,
asking for needs, and feeling proud or happy
Fisher, 2011

Copyright 2013: Janina Fisher, Ph.D.


Do Not Copy without Permission

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

The Role of Shame in the


Context of Trauma
[When] a relationship of dominance and
subordination has been established, feelings
of humiliation
humiliation, degradation and shame are
central to the victims experience. Shame,
like anxiety, functions as a signal of danger,
in this case interpersonal or social danger.
Judith Herman, 2006

Like anxiety, [shame] is an


intense overwhelming affect
associated with autonomic
nervous system activation,
inability to think clearly, and
desire to hide or flee. Like
anxiety, it can be contagious.
Herman, 2006

Why does shame stick like glue


glue
for decades after the trauma?
Shame is a survival response, as crucial for safety as the
animal defenses of fight, flight, and freeze
Not only is shame a powerful body response, it is
accompanied by meaning-making
meaning making that exacerbates the body
responses and creates a vicious circle of shame
Whereas fear focuses on the source of threat, shame feels
personal: its about me
Shame is often reinforced by other trauma-related
schemas, such as Its not safe to succeedto be selfFisher, 2010
assertiveto have needsto be happy

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Humans depend upon the same


defensive responses as animals
We either
cry for help

Or flee

Or we try
to fight

We
freeze
and try
to be
invisible

Or we submit
in humiliation

Shame as a Survival Resource


In conflict situations, there are just
two basic choices: to escalate or deescalate. . . . The inhibitory functions
of shame suggest that shame
functions as a defensive strategy
which can be triggered in the
presence of interpersonal threat. . . .
Gilbert & Andrews, 1998, p. 101

Shame signals (e.g., head down, gaze


avoidance, and hiding) are generally
registered as submissive and [appeasing],
designed to de-escalate and/or escape from
conflicts. Thus, insofar as shame is related
to submissiveness and appeasement behavior
behavior,
it is a damage limitation strategy,
adopted when continuing in a shameless,
nonsubmissive way might provoke very
serious attacks or rejections.
Gilbert and Andrews, 1998, p. 102

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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

After trauma is over, we


remember
remember
it with our bodies
Brain scan research demonstrates that traumatic
memories are encoded implicitly as bodily and
emotional states more than in narrative form
But when trauma is remembered
But,
remembered without
words, it is not experienced as memory. These
non-verbal physical and emotional memory states
do not carry with them the internal sensation that
something is being recalled. . . . We act, feel, and
imagine without recognition of the influence of
past experience on our present reality. (Siegel, 1999)
Fisher, 2009

When the images and sensations of


experience remain in implicit-only
form. . ., they remain in unassembled
neural disarray, not tagged as
representations derived from the past . . .
Such implicit-only memories continue the
shape the subjective feeling we have of our
here-and-now realities, the sense of who we
are moment to moment, but this influence is
not accessible to our awareness.
Siegel, 2010, p. 154

Fear and Shame in a Threatening World


Hyperarousal-Related Symptoms:
Anxiety, panic, terror, dread, racing thoughts
Fear, anger, and longing are predominant emotional states
Hypervigilance, mistrust, resistance to treatment
Response to triggers is action: fight/flight, self-destructive/addictive behavior

Sympathetic
Window of Tolerance*The frontal lobes
shut down
Optimal Arousal Zone:

Hypoarousal-Related Symptoms:
Parasympathetic
Ogden and Minton (2000);
Fisher, 2009
*Siegel (1999)

Depression, sadness, numbing


Preoccupation with shame, despair and self-loathing
Mistrust disguised by automatic compliance
Response to triggers is inaction: giving in, passive
resistance, inability to say No

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Neurobiological Purpose of Shame


[Schore, 2003]

By toddlerhood, before the development of greater topdown control, children need for their own safety to
respond quickly to inhibitory cues. Allan Schore
hypothesizes that shame develops at this developmental
stage as a neurobiological regulator that serves the
purpose of helping children inhibit behavior.
In a state of high energy and action-orientation, children
are sympathetically activated and more impulsive. To
inhibit such behavior, the parasympathetic system must
act as a brake. This simple autonomic device can be
protective unless parents fail to soothe shame states
Fisher, 2013

The Purpose of Shame, cont.


[Schore, 2003]

When shame rapidly down-regulates excitement and


impulsivity, the child freezes momentarily, then inhibits
the forbidden action. Sympathetic highs are interrupted
by rapid parasympathetic deceleration
When
Wh these
th
shame
h
experiences
i
are repaired
i d by
b the
th parentt
with soothing and clarification, resilience increases (Tronick)
But, in unsafe environments, shame must be over-used
to down-regulate fight/flight reactions and other
behavior unacceptable or unsafe in the environment.
Under conditions of neglect and/or abuse, shame states are
not repaired by the caregiver, decreasing resilience
Fisher,
2011

[Shame] perhaps more than any


other emotion is intimately tied to
the physiological expression of the
stress response. . . . This
underscores . . .the function of
shame as an arousal blocker.
Shame reduces self-exposure or
self-exploration.
Schore, 2003, p. 154

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Shame as a Source of Safety


In traumatic environments, because of its role in
downregulating activation, shame helps to drive the
animal defense of submission: shame responses cause us
to avert our gaze, bow our heads, and collapse the spine.
Amongg animals,, this is an appeasement
pp
signal
g
In an environment in which self-assertion is unsafe for the
child, shame enables the child to become precociously
compliant and preoccupied with avoiding being bad
This shame-related avoidance of potentially dangerous
behavior and procedurally learned submissiveness is
Fisher, 2013
adaptive in traumatogenic environments

Persistent Shame Responses


Reflect Procedural Learning
Procedural memory is the implicit memory
system for functional learning: skills, habits,
automatic behavior, conditioned responses.
Driving a car,
car playing an instrument,
instrument swimming or playing
tennis, riding a bike, shaking hands and making eye contact,
even dissociating or switching, are all examples of
procedural learning.
Procedural learning allows us to respond instinctively,
automatically, and non-consciously, increasing our
efficiency at the cost of a loss in reflective, purposeful
action
Fisher, 2006
Sensorimotor Psychotherapy Institute

Procedural learning facilitates


automatic responding
[Procedural] memory shapes how we
experience the present and how we
anticipate the future, readying us in
the present moment for what comes
next based on what we have
experienced in the past.
Siegel, 2006

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Annie on the topic of shame:


When I was young, my parts built their own little
world that explained what was happening to them.
And what was their explanation?

They thought, if I wasn't so bad and ugly and if I


didn't cause other ppeople
p to be angry,
g y, these things
g
wouldn't be happening to me."
What were the advantages of that explanation?

"It limited how much people could get to them. If


something is wrong with you, you can work on you.
You don't have to try to figure out why the bad
things are happening because you already know.

Sensorimotor Psychotherapy
Sensorimotor Psychotherapy is a body-oriented talking
therapy developed in the 1980s by Pat Ogden, Ph.D. and
enriched by contributions from the work of Alan Schore,
Bessel van der Kolk, Daniel Siegel, and Steven Porges.
Sensorimotor work combines traditional talkingg
therapy techniques with body-centered interventions
that directly address the neurobiological effects and
procedural learning of trauma. By using just enough of
the narrative to evoke the unresolved somatic experience,
we attend first to how the body has encoded traumatic
experiences and secondly to cognitive and emotional
meaning-making
Ogden, 2002; Fisher, 2006
Sensorimotor Psychotherapy Institute

The most direct way to effect change is by


working with the procedural learning
system. . .
. [Grigsby & Stevens, 2000]
The first [type of therapeutic challenge] is to observe,
rather than interpret, what takes place, and repeatedly
call attention to it.
Empathy is not helpful with shame: it reinforces
identification with the shame, rather than challenging it.
The second therapeutic tactic is to engage in activities
that directly disrupt what has been procedurally learned.
But the disruption cannot be shaming to the patient:
that requires that our disrupting must be done more
indirectly than directly.

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Psychoeducation
Psychoeducation is a good disruptor of shame:
Psychoeducation about the ability of shame and self-blame
to inhibit behavior that our parents will punish, to get us to
be seen and not heard
Psychoeducation about the role of shame in enforcing
submission for the sake of safety. Submission must be
understood as an active defense at those times when
fight and flight would be dangerous or impossible
Psychoeducation about shame and cognitive schemas:
The belief that you are worthless is a story you told
Fisher, 2009
yourselfit kept you alive

Challenges to Shame and


Self--hatred
Self
Mindfulness: help the client to notice the shame rather
than be it. What happens in the body when those
thoughts of worthlessness come up? Notice what its
like to observe the shame just as body sensation . . .
Dis-identification: challenging the identification with the
shame as who I am. Thoughts are just theorieslets
be curious about this theory that youre stupid. How
would that theory have helped you survive?
Reframing the shame: attributing meaning and purpose
to the shame as a survival resource (Ogden et al 2006).
The shame was the hero of your story. . .
Fisher, 2011

Mindfulness Skills
Notice . . .
Be curious, not judgmental. . .
Lets just notice that reaction youre having
inside as we talk about standing up to your boy
friend
friend
Notice the sequence: you were home watching
TV with your husband, feeling relaxed, then
suddenly you started to feel anxious, and then
you felt ashamed . . .
What might have been the trigger? Lets go
back to that day and retrace your steps. . .
Fisher, 2004

Copyright 2013: Janina Fisher, Ph.D.


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Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Differentiating Thoughts,
Feelings, and Body Experience
In traditional talking therapies, we tend to treat thoughts,
feelings, and body sensations as if they were one and the
same. But when clients say, I feel ashamed,
Their words could convey a cognition: I believe
that I am defective
They could communicate an emotion: Im feeling
humiliated right now
They could reflect bodily sensation: I feel a
flushinga sick feeling in my stomachan impulse to
Fisher, 2013
turn away and hide

Increasing mindful concentration:


offer a menu of possibilities
When the shame comes up, what happens? Do you feel
it in your stomach? Your face? Or do you want to hide?
you feel that anger,
g is it more like energy?
gy Or
As y
muscle tension? Or does it want to do something?
When you talk about feeling nothing, what does
nothing feel like? Is it more like calm? Or numbing?
When you say those words, It was my faultthere
must be something wrong with me, do you feel better or
Ogden 2004
worse?
Sensorimotor Psychotherapy Institute

Putting words to experiences of


shame facilitates selfself-blame
Human beings are meaning-making creatures. Early in
life, before we have words, brain and body make meaning of
our experience. With language, we begin to attach words
Echoing what they heard from caregivers, our clients have
attached words of blame: You

stupid idiothow could


you be so dumb? Youre disgusting Loser!
The words of blame serve to re-evoke the shame,
enforcing compliance needed to preserve safety/attachment
But children believe the words of blame as truth
about themselves. Although that belief is protective, it
fuels automatic self-blame and thus more shame Fisher, 2013

Copyright 2013: Janina Fisher, Ph.D.


Do Not Copy without Permission

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Procedurally--learned SelfProcedurally
Self-Hatred
Self-blame serves the purpose of putting the brakes on
behavior that will be punished by others. In self-blame,
we yell at ourselves, inducing shame. We warn ourselves
never to do that again; we silence ourselves; we withdraw.
The key here is that shame is active and protective
Internalizing the punitive role ensures safety and a greater
sense of controlat the cost of punitive introspection. But
self-hatred is a small price to pay for greater safety.
Once self-hatred is procedurally-learned and encoded
in the body and mind, it feels true. It continues to
exert an influence on self-esteem and healthy self-assertion
long after its job is over
Fisher, 2012

Shame and Blame


Annie F.: Blame' and 'shame' are best friends. When
my parts blame themselves for what was done to them,
they are saying that they did 'something' wrong. And
that 'something' had consequences.... such as that my
body was bruised, or eyes swollen from crying, or hair
messedd up and
d tangled,
l d andd even a fat
f belly
b ll from
f
a
rape. That 'I' was to blame for looking and feeling so
badly was just the beginning of my shame.
Annie F.s epiphany describes blame and self-loathing as
essential ingredients of shame as a survival response. The
blaming thoughts instigate shame responses followed by
automatic submission responses
Fisher, 2010

Cognition and the body


The body responds not only to physical and emotional
stimuli (sights, sounds, touch, facial expressions) but also
to words and the tone in which they are spoken
Good job! evokes a different bodily response than You
did a terrible job!
job! What
What are you doing here?
here? has a
different impact than Welcome---its good to see you
In order to treat the body aspect of the shame response,
we need to help clients notice the vicious circle between
the words they use and the body responses evoked
And we have to help them experiment with new words
that have a different impact on body experience Fisher, 2011

Copyright 2013: Janina Fisher, Ph.D.


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10

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Dropping the Content


Content

An important sensorimotor skill for decreasing shame is


learning to drop the content:
content: to focus away from
shame--based thoughts, interpretations and feelings and
shame
instead to focus attention toward the body sensations OR
just external stimuli
For mindful clients, dropping the content and shifting
focus to internal body awareness can be regulating. For
less mindful or more unstable clients, letting go of the
content
content is only possible when they focus on something
concrete, such as their feet
Dropping the content to focus on the body challenges
negative cognitions: the words lose their power Fisher, 2008
Sensorimotor Psychotherapy Institute

Combating Shame Through the


Body
If the shame is reinforced or exacerbated by body
experiences of collapse, loss of energy, feelings of
revulsion, curling up or turning away, then shame can be
g
by
y changing
g g body
yp
posture
mitigated
Lengthening the spine and grounding through the feet
both challenge shame. If the clients head is bowed or
averted, bringing the head up or asking the client to begin
to slowly turn the head and lift the chin can begin to
increase feelings of confidence and fearlessness. If these
movements are triggering, they can be executed piece by
Fisher, 2009
piece over time
Sensorimotor Psychotherapy Institute

Fisher, 2000

Copyright 2013: Janina Fisher, Ph.D.


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11

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Clinical Advantages of Working


with Shame as a Child Part
When we re-frame shame or self-hatred or schemas as just
a part of the self, we interrupt procedurally-learned
automatic shame responses and increase curiosity
The language of parts also increases mindfulness: I
I
is the first word in a narrative about the shame, while the
language of parts encourages noticing internal experience
If there is a part that holds shame and a part that holds
blame, by definition there is a part that sees those
other parts (an observing ego). There may even be parts
that hold a more updated view of who the client really is
Fisher, 2011

Working with Ashamed Parts


Shame: The ashamed parts shame is best addressed as a
somatic resource. Explore its role in how the client
survived: how did it serve to regulate fear? Or anger? It
couldnt stop the perpetrators, but how did it protect the
child? Did it support the child being
being seen and not heard
heard??
Shame and self-loathing-related cognitions: when reframed as survival beliefs held by parts, shame-based
cognitions lose their power. How did it help that the
ashamed part believed that she deserved the abuse?
What would have happened if she had believed he was
wrong? What would have happened then?
Fisher, 2013

Working with Beliefs as Child Parts


Ask the client to assume that the belief is held by a
part of the self: What part believes she is worthless and
undeserving? What part believes it isnt safe to trust?
When that part feels shame, what happens in your body?
Increase the clients
client s mindful curiosity: How
How would it
have been adaptive for that part to be convinced that she is
worthless and undeserving? How did that affect your/her
behavior in your family environment?
Most often, the belief served a defensive function. It
was a survival resource: Yes, the ashamed part is the
hero of your story, isnt she? She kept you safe. . . What
happens inside as she takes that in?
Fisher, 2009

Copyright 2013: Janina Fisher, Ph.D.


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12

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Establishing relationships
between adult self and parts
Trauma alienates us from ourselves and our parts from
each other. To combat shame requires welcoming
ashamed parts and evoking mindful curiosity about their
feelings, thoughts, and impulses.
Bringing them alive naturally enhances empathy:
How old might this part be? Very young? Middle-sized?
A teenager? Is this part more emotional or logical?
As curiosity challenges the automatic animosity toward
parts and they come to be better understood, the therapist
can ask an Internal Family Systems (Schwartz, 2001) question:
And how do you feel toward that part now? Fisher, 2012

Establishing relationships with


parts, cont.
How do you feel toward this part now? is a question
that naturally invites compassion and is also a litmus test for
mindfulness: does the client have enough mindful
distance to feel curiosity or compassion for this part?
If the client responds with hostility, we can assume that she
is blended (Schwartz, 2001) with parts that judge the ashamed
part as weak or shameful. If the client responds, I
feel badly for her or I want to help him, we know that a
relationship is beginning to form.
The key to establishing compassion for ashamed parts
is the appreciation of their role in survival
Fisher, 2012

Neuroplasticity and the Role of


Repetition
. . . the brain changes physically in
response to [new] experience
experience, and
new mental skills can be acquired
with intentional effort and focused
awareness and concentration.
Siegel, 2010, p. 84

Copyright 2013: Janina Fisher, Ph.D.


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13

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Principles of Neuroplastic Change


The first principle is that neuroplasticity is induced by
changes in the amount [and kind] of sensory stimulation
reaching the brain (Schartz & Begley, 2002, p. 16).
The second principle is that neuroplasticity has to be
directed: calculated,, repetitive
p
p
patterns of stimulation
are necessary to obtain specific brain change. That
requires us to be active, unafraid to be repetitive to direct
the client in changing his/her habitual actions and reactions
Third, neuroplasticity requires focused attention.
Attention stimulates neuronal firing in the areas we wish to
restructure and also helps the brain to retain the new
learning.
Fisher, 2013

Principles of Neuroplasticity, cont.


The last and perhaps most important principle:
neuroplastic change requires that we help clients
consistently inhibit the old responses and then
engage in intensive repetition of new, more
adaptive
d i responses.
We cannot develop new patterns if we habitually
engage in procedurally-learned patterns or fail to
practice new habits. Whether we directly teach
clients to inhibit self-blame or indirectly disrupt
their habitual patterns, it is a prerequisite for change
Fisher, 2013

"If I accept you as you are, I


will make you worse. If I treat
yyou as though
g you
y are what yyou
are capable of becoming, I will
help you become that."
Johann Wolfgang von Goethe

Copyright 2013: Janina Fisher, Ph.D.


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14

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

Brain to Brain: interactive regulation


As we consistently re-frame the shame as a child part or a
trauma-related belief or life-saving procedural learning, it
slowly becomes easier for clients to inhibit their automatic
self-blame or thoughts of self-loathing
g eyes
y
communicate that the clients
As our shining
ashamed or judgmental parts are welcome and valued here,
clients begin to develop greater capacity to turn
shining eyes on their younger selves.
As our faces soften and our voices become warmer, the
client begins to soften as well, relaxing the body and
creating a pervasive sense of warmth. OUR acceptance
Fisher, 2012
becomes THEIR acceptance.

Annie: Until today it didn't seem possible


that the ashamed parts would ever feel any
respite from the searing embarrassment caused
by any mention or reference to the kinds of
crimes committed against them as children. In
the minds of the parts, they were complicit in
the acts against them. The warriors thought of
the ashamed parts as weak and disgusting, too,
not as vital to my survival. And I wasn't
helping those ashamed child parts because I
was blended with them.

Shame is a powerful weapon that the abusers


counted on. I can see that now. How different it
feels in my body to acknowledge submission as a
survival tactic that was smart and courageous of
my young parts to access! Their submission and
subsequent shame may be the reason we
survived. So, now there is more hope for
healing. Every time I '"hang in there" with my
back straight and my feet firmly planted on the
ground, the parts that feel so much shame will
see that they are really heroes.

Copyright 2013: Janina Fisher, Ph.D.


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15

Shame and Self-Loathing in the Treatment


of Trauma

PESI Webcast
Monday, December 9, 2013

For further information:

Janina Fisher, Ph.D.


5665 College Avenue, Suite 220C
Oakland, CA 94611 USA

DrJJFisher@aol.com
www.janinafisher.com

Sensorimotor Psychotherapy Institute


www.sensorimotor.org

Sensorimotor Psychotherapy
Institute Training for the
Treatment of Trauma
www.sensorimotor.org
For information, email:
trainings@sensorimotor.org

Working with the Neurobiological


Legacy of Trauma
A Monthly Webinar Series
on Complex Trauma and Dissociation

A ten-month remote-learning webinar program for


mental health professionals interested in developing
greater
g
comfort and expertise
p
in working
g with complex
p
trauma and dissociation while staying abreast of recent
trauma-related research and treatment advances.
All programs are recorded and available for later viewing online.
For more information or to register, email Dr. Fisher or go to
www.janinafisher.com
Janina Fisher, PhD. is a clinical psychologist specializing in treatment of complex PTSD and dissociation. She
is also an instructor & supervisor at the Trauma Center, past President of the New England Society for the
Treatment of Trauma & Dissociation, a trainer for the Sensorimotor Psychotherapy Institute, an EMDR Approved
Consultant, and an international presenter on the neurosience research and treatment of trauma-related disorders.

Copyright 2013: Janina Fisher, Ph.D.


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16

Overcoming Trauma-Related Shame and Self-Loathing with Janina Fisher,


Ph.D.
Program Objectives
Please use the objectives below to answer the online objective questions.
At the completion of this seminar, I have been able to achieve these seminar
objectives:

Help clients appreciate the role of shame and self-loathing as symptoms of


trauma
Identify the neurobiological effects of shame
Discriminate the physiological and cognitive contributors to shame
Describe cognitive-behavioral, ego state, and psychoeducational
interventions to address shame

**Please mark any additional objective questions online not applicable.