Navigating Systemic Betrayal and Rupture - Together as Resistance

Abstract
This workshop will explore the complex intersections of systemic betrayal, healthcare instability, and the treatment of complex trauma and dissociation. The current socio-political context in the U.S., and specifically Oregon, will be used as a case example. On July 31, 2025, thousands of Oregon-based providers and their clients learned that they would no longer be able to continue working together through one of the largest Medicaid coordinated care organizations, with only 60 days’ notice. Providers were forced to rapidly pivot their clinical care and business models, often with minimal information, while clients faced sudden uncertainty in access to essential services. This abrupt disruption carries significant clinical risks, particularly for individuals living with complex trauma and dissociation, whose treatment depends on consistency, stability, and long-term relational trust.

Providers working in the field of trauma and dissociation are acutely aware of the many forms of instability, betrayal, and unmet needs that are woven into clients’ histories. These very dynamics are echoed and amplified by systemic ruptures in the healthcare system itself, creating an environment where clients are retraumatized by the very institutions intended to support their recovery.

For people living with complex trauma and dissociation, abrupt systemic ruptures create more than administrative challenges — they shake the foundations of safety and predictability that therapy relies on. When continuity of care is disrupted, stress responses intensify and symptoms can escalate. Dissociative processes may become more pronounced, with parts holding trauma content activated under heightened stress while other parts struggle to manage daily life. Clinically, this can look like increased dissociation, emotional overwhelm, or a collapse of trust in the therapeutic relationship. In this way, systemic betrayal not only threatens access to care but also deepens the very patterns of fragmentation and instability that treatment seeks to repair.

Alongside the direct impact on clients, systemic rupture generates significant moral injury for providers. Many clinicians are forced to terminate care against their values, witnessing preventable harm and experiencing betrayal by the very systems in which they practice. Moral injury in this context undermines clinicians’ sense of efficacy and presence, and addressing it is inseparable from supporting client well-being.

A critical dimension of response lies in collaboration and collective action. In Oregon, providers began to organize, share resources, and advocate for clients. These efforts highlight how collective responses can mitigate isolation, sustain ethical practice, and model resilience for clients navigating systemic trauma. Collaboration among providers offers not only pragmatic solutions but also a form of resistance that reaffirms professional values of care, justice, and continuity.

In this workshop, presenters will share clinical observations, examples of collective organizing, and strategies for supporting clients while navigating bureaucratic rupture. Participants will be invited into dialogue to generate shared strategies for sustaining trauma-responsive, relational care within unstable systems. By situating these issues within the broader theme of “Past Perspectives, Future Horizons: Navigating Changing Currents of Complex Trauma and Dissociation,” this workshop offers both a critique of systemic barriers and a vision for sustaining ethical, collaborative, and socially-just practice amidst instability.