Beyond Trauma Informed Care: Dignity Affirming and Shame Sensitive Practice

Abstract
A generation ago, the concept of trauma informed care ushered in a paradigm shift in health and welfare service, promoting humanising and person-centred care for survivors of abuse and violence. However, models of trauma-informed care are focused on post-traumatic stress disorder and are not sensitised to the unique needs of people with complex trauma and dissociation. Trauma informed care policies and practice guidance are often silent on how to engage and support severely dissociative people, in particular.

Our plenary presents dignity-affirming and shame sensitive practice as the next generation of trauma informed care. Drawing on our own research and experience, as well as seminal work by Dolezal and Gibson, we outline the key features and characteristics of shame-sensitive practice, recognising that shame is the core emotional correlate of complex trauma and dissociation. Whereas trauma-informed care remains grounded in a medical model of psychological injury, shame-sensitive practice acknowledges that shame is a shared response to abuse, violence, inequality and discrimination. We position shame sensitivity as the proactive responsibility of professionals and services.

Dignity affirming care draws on the philosophy and praxis of non-violence. Rather than the absence or prevention of shame, dignity affirming care promotes practices and processes that directly oppose shame, providing for abiding and embodied experiences of feeling valued and important. We explain the key features of processes of “dignification” and the ways in which services and professionals can communicate directly to clients that they matter.

The presentation provides concrete examples of the intersecting psychological, social and political dimensions of shame, with a focus on race and racism. Childhood trauma, disorganised attachment and social defeat are situated within the broader context of racial inequality and racist backlash in ways that corrode mental health, but also impact on access to mental health care and diagnostic practice. We explore the role of clinical care in the amelioration of shame and the promotion of dignity, drawing on philosophies of non-violence to consider how we attribute responsibility for harm within frameworks of dignification.

Potential to Distress: No

This presentation was originally presented as part of a live hybrid conference in March 2024.
 

Target Audience

Beginning/Introductory

Learning Objectives

At the conclusion of this presentation, participants will be able to: 

  • Describe the types of shame experienced by people with complex trauma and dissociation in their service encounters
  • Identify the characteristics of shame-sensitive practice
  • Design processes of dignification in mental health settings
  • Compare trauma-informed care to dignity affirming and shame sensitive practice
  • Analyse the role of social equality in shame and mental health
Course summary
Available credit: 
  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Course opens: 
06/01/2025
Course expires: 
12/31/2025
Rating: 
0

Michael Salter, PhD
Professor Michael Salter is the Director of Childlight UNSW, based in the School of Social Sciences at the University of New South Wales, Australia. Childlight UNSW is the Australasian hub of Childlight, the Global Child Safety Institute, dedicated to the study and prevention of child sexual abuse and exploitation. Professor Salter is an internationally recognised expert in the study of child abuse, violence against women and complex trauma. His published work includes the books Organised Sexual Abuse (2013, Routledge) and Crime, Justice and Social Media (2017, Routledge) and over fifty papers in international journals and edited collections. Dr Salter is a past president of the International Society for the Study of Trauma and Dissociation (ISSTD) where he has served on the Board of Directors since 2018. He is the Chair of the Grace Tame Foundation, which is dedicated to the prevention of child sexual abuse. Dr Salter sits on the editorial boards of the journals Child Abuse Review and the Journal of Trauma and Dissociation. Dr Salter is a member of a number of advisory groups, including the Advisory Group of the National Plan To Prevent Violence Against Women and Their Children, the Expert Advisory Group of the eSafety Commissioner, and the Research Working Group of the Australian Centre to Counter Child Exploitation. Current projects include a study of legal and practice responses to the intersections of domestic violence and child sexual abuse, the national survey of LGBTIQ+ experiences of sexual violence, and a study of the extent of distribution of child sexual abuse material of known Australian victims.

Heather Hall, MD
Dr. Heather Hall is a board-certified psychiatrist practicing privately in Northern California. She has been in practice for over 30 years, specializing in the treatment of childhood trauma survivors. Dr. Hall has a B.A. in biochemistry from Smith College and an M.D. from Drexel University. She completed her psychiatric training at Pennsylvania Hospital and the Institute of Pennsylvania Hospital. Dr. Hall was an associate clinical professor at UC, San Francisco, and UC, Davis, where she was an award-winning teacher and psychiatry resident supervisor. She served as a unit chief of several cultural focus units at San Francisco General Hospital. The cultural focus units specialize in care for the seriously mentally ill from severely disadvantaged communities in and around San Francisco. It was in San Francisco that she began to develop the theory that social defeat, in combination with disorganized attachment, led to dissociative coping skills that were often misdiagnosed as schizophrenia. Dr. Hall is an active member of the International Society for the Study of Trauma and Dissociation, currently co-chair of the public health committee. In addition, she has served as chair of the annual conference committee and a member of the board of Directors. Dr. Hall has also received several honors and awards from the ISSTD, including the Pierre Janet Writing Award, the President’s Award of Distinction, and the Distinguished Achievement Award. Moreover, she has published several articles on trauma and dissociation in peer-reviewed journals, such as the Journal of Trauma & Dissociation and Trauma, Violence and Abuse. Dr. Hall is passionate about helping people heal from trauma and live fulfilling lives.

Available Credit

  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
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