For clinicians working with clients who experience persistent dissociative processes, one of the most challenging questions is what it truly means to feel real. In this engaging volume, Richard A. Chefetz presents a deeply relational approach to intensive psychotherapy that tackles the core fear underlying dissociation. Drawing on decades of experience, Chefetz illustrates how dissociative defences protect individuals from overwhelming affect—and how therapy can gently help them reclaim a sense of authentic presence. This book is not merely a technique manual; it is an invitation to think more profoundly about the therapeutic relationship and the therapist's own emotional engagement as a catalyst for change.

The Relational Approach and Its Significance

Traditional models of dissociation often emphasize symptom management or memory recovery. Chefetz argues that what many clients need most is a relationship that can hold their fear without collapsing. He describes how the therapist's willingness to be vulnerable—to be affected by the client's pain—can paradoxically help the client feel more real. The book is praised by clinicians for its honesty and its ability to translate complex theory into actionable understanding. By focusing on the therapist's own emotional process, this book stands apart from many other texts on dissociation.

Clinical Insights You Can Apply

Chefetz weaves together multiple streams of knowledge: psychodynamic theory, attachment research, interpersonal neurobiology, and trauma studies. He shows how dissociative processes are not simply pathological but adaptive responses to early relational failures. The book includes rich clinical vignettes that illustrate how to work with the therapist's own feelings of confusion, helplessness, and even dissociation in the consulting room.

• Neurobiological perspectives: How the brain organizes experience in states of trauma and how therapy can foster integration.
• Relational depth: The therapist's use of self as a tool for healing, including honest discussions of countertransference.
• Practical strategies: Ways to pace sessions, address enactments, and support clients in tolerating uncomfortable emotions.

Who Will Find This Book Valuable?

This book is written primarily for mental health professionals: psychiatrists, psychologists, social workers, counsellors, and graduate students. It assumes some familiarity with clinical concepts but remains accessible to those willing to engage with challenging material. Readers who work with trauma survivors, clients with borderline personality disorder, or anyone struggling with a fragmented sense of self will find relevant insights. While the book is rooted in intensive psychotherapy, its lessons apply across therapeutic modalities. It is also relevant for supervisors, educators, and anyone interested in the interpersonal neurobiology of dissociation.

A Closer Look at the Norton Series on Interpersonal Neurobiology

This volume is part of the esteemed Norton Series on Interpersonal Neurobiology (IPNB), which integrates findings from neuroscience, attachment theory, and psychotherapy to illuminate human development and healing. The series is known for bridging research and practice, and this book continues that tradition. Richard A. Chefetz, a seasoned clinician and teacher, brings the IPNB framework to life through his narrative style and clinical acumen. The series is widely respected among therapists seeking a deeper understanding of the brain–mind–body connections in therapy.

Considerations for Practice

This book is a clinical resource and should be used as part of ongoing professional development. It is not a substitute for personal therapy or supervised clinical training. Readers are encouraged to engage with the material thoughtfully and to consult supervision when applying new approaches to their work. The insights offered here can deepen one's capacity to be present with clients who struggle to feel real.