Absence: Shame, Dissociation and Psychotherapy with Attachment Trauma in non-DID and DID Clients

Abstract
In the broadest terms, Attachment Trauma (AT; Farina & Schimmenti, 2025) in non-DID and DID can be thought of as chronic consequences of the emotional and relational pain of what repeatedly happened that shouldn’t have, as in abuse, and what didn’t happen that should have, as in neglect or what we refer to as “absence”. According to Farina & Schimmenti (2025), AT “is a condition that emerges within primary attachment relationships, in which prolonged and severe failures in protection, regulation and caregiving, and/or the occurrence of active and ongoing abuse, represent lasting or recurrent threats from which the child is unable to escape.” If we bring our attention to the infant and young child faced with extreme failures or absence of protection, regulation, and responsive care, then how can we describe their experience?  What are the effects, in mind, emotion, and body, of “the absence of presence and the presence of absence” not only for the child, but for the adult survivor of AT as seen in the non-DID or DID patient?  How do we identify these effects in the adult who endured unbearable aloneness, particularly when these “memories” are not stored in narrative or episodic form?  How do those of our non-DID and DID patients who have endured unremitting “absence” remember the pain of what never happened that should have, and how do we begin to help them psychotherapeutically?   Further, what is the relationship between traumatic, mind/body shame states, particularly the shame of existing (Wille, 2014), and the caregiver’s repeated failure to attend and respond reciprocally to their child?

With a focus on the adult survivor of non-DID attachment trauma, Dr. Benau will begin by presenting some developmental research, theory, and concepts pertaining to the effects of early childhood, caregiver absence. He will also introduce some thoughts about the relationship between caregiver absence, chronic shame states, and dissociation. Dr. Hohfeler will extend this conversation to include the role of chronic caregiver absence, counterpointed with intrusive inductions of shame and terror, in the development and maintenance of clinical phenomena observed in patients with DID.  Drs. Benau and Hohfeler will next present several clinical vignettes, in order to show some of the many ways “absence” makes its presence known in psychotherapy with AT survivors living with non-DID and DID. Opportunities for questions and answers, and conversation pertaining to participants’ clinical experience with the chronic effects of absence, will occur throughout this workshop.