Trauma, dissociation and shame. An addiction treatment

The addiction recovery process needs to go through a qualitative change in the way a patient relates to others and himself.In this report, a therapeutic process is described, showing the way both patient´s and therapist´s subjectivity interact. The case is about a 35 years old man, addicted to cocaine. The patient kept assisting to treatment sessions, in the context of an addiction program. A collaborative relationship with his individual therapist was developed, validating its contribution and mutual understanding. Nevertheless, things changed when it was discovered that the patient had lied during 3 months. Despite the fact he had asserted he had been abstinent, he had been consuming cocaine 3-4 times a week. Due to different reasons, the treatment system failed at practicing weekly urine screening. After the hidden consumption was opened, Joseph reacts both indifferently and aggressively. The therapist feels annoyed and confronts the patient. A therapeutic impasse is generated.The center of this case analysis is both patient´s and therapist´s shame. This feeling is related to patient´s relational trauma. Two enactments are discussed, understanding them as signs of dissociated shame, addict/patient dissociation and validated/cared self dissociation. A context of high therapeutic expectation amongst addiction treatments is also considered.