Sometimes a patient vacillates between angry attacks on the therapeutic relationship and tenacious attachment to it. As a participant in the relationship, the therapist will inevitably also experience difficult feelings. The clinical atmosphere can be so poisoned by such extremes of push and pull between the participants that it can cause emotional exhaustion, shame and fear of humiliation, intolerable loss, intense dislike, disgust, and contempt.

As we now know, patients who have experienced frightening parents and disorganized/disoriented attachment in their early development will likely demonstrate a degree of chaos in their present attachment relationships. But when shame-contempt dynamics are present, the behaviors we see may exceed even the predictable, and establish patterns of “baiting” between therapist and patient. In this conference, Dr. Chefetz will describe these dynamics and how to identify them. Additionally, he will offer suggestions for understanding and working with patients when our clinical relationships include these types of extremely difficult dynamics.

At the conclusion of this conference, 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. Describe the parental contribution to each of the four major infant attachment styles and their clinical relevance to adult psychotherapy and the exploration of a traumatic past.
  3. Explain how “attackment” describes a shift from proximity seeking in the attachment paradigm to guaranteeing distance when domination-submission, power and control, dynamics overwhelm the interpersonal world of a child.

This conference is appropriate for mental health professionals at all levels of experience and offers 3 CEs.

About our Presenter:

Richard A. Chefetz, MD 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), Co-Founder and Chair of their Dissociative Disorders Psychotherapy Training Program (2000-8) 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 Baltimore 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,” Psychiatric Annals, August 2005, and “Multimodal Treatment of Complex Dissociative Disorders,” Psychoanalytic Inquiry, 20:2, 2000, as well as numerous journal articles on psychoanalytic perspectives on trauma and dissociation. In 2015 he published Intensive Psychotherapy for Persistent Dissociative Process: The Fear of Feeling Real, with W.W. Norton, in their Interpersonal Neurobiology series.

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Conference Fees:
Free for all ICP+P Members / MITs / Fellows
$90 for Non-members
$30 for Graduate Students

For more information or to request reasonable accommodations, email
A refund for cancellation is available up to 10 days before the conference.

To register by mail, send this page and payment to:

4601 Connecticut Ave., NW, Suite 8
Washington, DC 20008

Continuing education credit: 3 CE credits available for full attendance. The Institute of Contemporary Psychotherapy and Psychoanalysis (ICP+P) is approved by the American Psychological Association to sponsor continuing education for psychologists. ICP+P maintains responsibility for this program and its content. ICP+P is approved by the Maryland Board of Social Work Examiners to offer Category I continuing education credit. Because ICP+P has approval from the Maryland Board, CE credits hours awarded by ICP+P may also be claimed by social workers licensed in Virginia and the District of Columbia. These continuing education credits meet the ANCC standards for nurses. Marriage and family therapists licensed in the District of Columbia, Maryland, and Virginia may submit these CE credits to their licensing boards. (Marriage and family therapists in other jurisdictions and licensed counselors should inquire with their local Boards regarding continuing education credit.) Attendees from the above professional groups will earn 3.0 CE credits for attending the conference. Full attendance is required to receive the designated CE credit. ICP+P is accredited by MedChi, the Maryland State Medical Society to provide continuing medical education for physicians. ICP+P designates this educational activity for a maximum of 3.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

* Richard Chefetz, MD and the planners have informed us that they do not have a conflict of interest and have disclosed that they have no relevant financial relationship with any commercial interests pertaining to this educational activity. Additionally, the presenters have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during this presentation. This presentation will not contain any references to off-­label (non-­FDA approved) use of products or devices.

CE Credit is granted to participants with documented attendance at individual workshops and completed evaluation forms for those sessions. Credit will not be granted to registrants who are more than 15 minutes late or depart more than 15 minutes early from a session. Please arrive at least 10 minutes before the scheduled start time to allow time to check in.