Removing the Cloak of Shame

Exercise

Shame in the Therapeutic Process

Journal about a personal experience of shame. Pay particular attention to ways in which you tried to hide. Also look at ways in which you worked through your feelings of shame or things that you think would have helped you to work through your feelings of shame

The Client's Shame

Video - Brene Brown

Money

“Because of the power

imbalance between patient and therapist, and because the patient exposes hisor her most intimate thoughts and feelings without reciprocity, the individual

therapy relationship is to some degree inherently shaming.” (Herman)

Etiology of Shame

Sources of Shame

The perfect client

• The client
• The therapeutic interaction
• The counsellor

Adaptive "appeasement" functions in primitive societies. Used to reaffirm rank in the hierarchy in order to avoid physical confrontation. Accompanied by increased Cortisol levels indicating a stress response.

Born of unsuccessful attempts to resolve psychological or behavioural problems and the stigma associated with such problems

Definitions

Although shame is found in every corner of the counselling room it is easily overlooked or actively avoided

Researchers divided on whether or not shame is ever adaptive in modern society

• Shame related to purpose (e.g., feeling ashamed of desires, dreams, fantasies, or sense of purpose)
• Shame related to affect (e.g., regarding specific emotions such as anger or pride or regarding intense emotional experience)
• Shame related to sexual drives and hunger drives
• Shame related to interpersonal needs.

Shame

“The intensely painful feeling or experience of believing we are

flawed and therefore unworthy of love and belonging”

Shame Resilience

"A person’s ability to recognize and understand shame, move through it constructively while maintaining a basic level of authenticity, and increase his or her level of courage, compassion, and connection as a result of experiencing shame."

Impact on Counselling Process

(Brown, 2007)

• Clients are inclined to hide shameful thoughts, emotions, and behaviors, important material is missing
• Shame-based anger and rage that can be directed toward the therapy work and/or the therapist
• Counsellor shame can inhibit the ability to work effectively

Outline

Shame and Suicide

Removing the Cloak of Shame

Kiersten Kneisel, M.A.

Shame-induced suicide is especially likely when clients feel exposed to public observation and condemnation (e.g., a government official about to be exposed for a scandal) or when clients feel

deep despair for their failure to live up to life aspirations and ideals

Therapists may experience anticipatory

shame when faced with a suicidal client, envisioning the shame of failing as a

therapist should the client actually commit suicide and the shame and humiliation

of being taken to court for failing to prevent the suicide

• May lead to overly conservative actions
• In the extreme case of the suicidal patient who refuses hospitalization, the patient is rendered helpless [i.e., humiliated and shamed] if the therapist hospitalizes her against her will; alternatively, the therapist is helpless [i.e.,humiliated and shamed] if he disregards evidence of high risk.” Herman recommends that, in such instances, clinicians explicitly describe the therapeutic dilemma, thus allowing the client to recognize and own both sides of the conflict rather than projecting one side (the role of victim or perpetrator) onto the therapist.

Shame & Self Esteem

Shame Responses

Shame in Counselling

Working with Shame

More Tools

• Recording sessions
• Two Chair Dialogue - Condemner & Condemned
• Coping strategies: individual & relational
• Five A's:
• Attention: I have time for you.
• Approval: I like what you do.
• Acceptance: It’s OK for you to be you.
• Admiration: I can learn from you.
• Affirmation: I celebrate your existence.
• Group Therapy
• Normalisation
• Teaching by example
• Different power dynamics than individual counselling
• Self-Disclosure

Recognizing Shame

• decreased eye contact, slumped or rigid posture
• avoidance of “here-and-now” material
• freezing, stammering, tightened voice, self-deprecating comments that expand into hilarious monologues, and an “infinitesimal flash of irritation” before apology for a missing or incomplete homework assignment
• downcast eyes, squirming or writhing in the seat, laughter or shrugging off that covers embarrassment, and indications that it is somehow degrading to be in therapy. may go blank, show submissive crouched body postures, avoid topics (e.g., talk around topics but not clarify them), become anxious or angry, or point-blank refuse to reveal” relevant clinical material

Assessment

Common Mistakes & Remedies

Objectification =====> Collaboration

Intrusive Interpretation ====> Uncertain Presentation

Class Exercise - Code words for shame

Shame in the Counsellor

Domain-Specific:

• appearance and
• body image
• money and work
• motherhood or fatherhood
• family
• parenting
• mental and physical health (including addiction)
• sex
• aging
• religion
• speaking out
• surviving trauma
• being stereotyped and labeled

Overall Tendencies

“I am not good,” “I am not good

enough,” “I do not belong,” “I am unlovable,” “I should not be.”

Mistakes can be Golden Opportunities!

Cultural Considerations

References

"Perhaps more than any other emotion, culture colors how, when, and why shame is experienced and

expressed, thus further complicating an already complicated picture."

Language barriers can be shaming

Video Exercise - Recognizing Shame

Tangney, J.P., & Dearing, R. Working with shame in the therapy hour: Summary and Integration

Watch out for assumptions that shame is maladaptive! Use psychoeducation to educate the client about the purpose of accessing and expressing shame.

"The challenge of providing therapy, with all its uncertainty, can engender shame in a therapist who, rather than being a paragon of psychological health, brings to the therapeutic encounter very human limitations and vulnerabilities."

Sources:

• identification with a client whose shame issues are similar to those of the therapist
• mistakes made in session
• unsuccessful treatment outcomes
• unfavorable comparisons with colleagues and much more!

Working with Shame

Cultural stigmas about mental illness

Collectivist cultures

Where possible use culturally relevant rituals!

Group therapists especially vulnerable

Relational Validation

• Rapport
• Working from client's values

Accessing & Acknowledging Shame

• Bringing shame out of the corner and into the light
• Verbalising events and experiences
• Re-framing such events
• Titrating so client “experiences dignity in the telling”
• Psychoeducation
• “accept the client’s shame rather than try to argue it away.” - can be invalidating
• Anger as a defense against shame
• Labeling shame?

Shame Regulation

• Self-soothing or distraction
• Mindfulness & ACT
• Self-compassion - ask the client to imagine giving advice or comfort to a real or imaginary friend who has a similar shame-inducing problem

Transforming Shame

• Shame (condemning the person) ===> Guilt (condemning the behaviour)
• Examining Perectionism
• Self-forgiveness & Spirituality
• Justified Shame: Apologizing and repairing the damage, committing to and implementing an effective plan to solve the problem (e.g., anger management therapy), and accepting consequences
• Inappropriate Shame: Examine culpability
• Opposite Action

Supervision can help with shame resilience!

Be wary of perfectionism!

Metashame - being ashamed of being ashamed!