Intersectionality teaches us that inequality and discrimination are determined by a complex interplay between socially-constructed identities. The resulting states of otherness can introduce intersectional shame into the clinical encounter. When a fat analyst and fat patient share marginalized difference, their mutual shame can multiply across their relationship, producing an intersectional enactment. Exponentially high degrees of shame create a compounded need to disavow associated “not-me” self-states, resulting in a failure of reflective awareness with potentially significant consequences. Thus, it can take a radical, destabilizing intersectional enactment to penetrate this mutual dissociation. In such instances, the dramatic intensity of an intersectional enactment may represent the key to understanding it.