May 3rd, 2012 admin
Webinar and Special Events:
My webinar sponsored by the ISTDP Institute on “Interrupting Defenses as a Form of Compassion” is coming up on 5/11/12. Go to istdpinstitute.com to register. There will be live role plays to demonstrate how we can work effectively with a wide variety of defenses.
Also, I’m offering a one day special event to be held on both 6/9 in LA and 6/16 in Glendale on “Penetrating Defenses to Awaken the Self.” Go to www.warrenwarshow.com to register! This event includes recorded session material showing a style of dissolving defenses that conveys and evokes compassion for self in our clients/patients.
SHAME AND GUILT
We’ve had a passionate exchange of ideas and conflicting perspectives within our professional community on how to conceptualize and deal with shame and guilt with our patients. Are they affects? Do they inhibit, hence are they “inhibitory affects,” or are they defenses to be treated as we treat all defenses?
As I share my perspective, I put forth one caveat, I do hold all my theories lightly, as suggested by Nemeroff!
As I see this, shame, the toxic form of guilt and anxiety are emotions that lead to defenses that do inhibit the process of reparation and healing. I explain shame and guilt to my patients as painful feelings (like anxiety) that then lead to various distancing, repressive or self attacking defenses. “You feel anxious over an underlying painful feeling, then you put a wall up of detachment to avoid both anxiety and underlying feeling.” “Your friend says he was hurt by your action. You feel guilt, which is a very painful feeling, then you withdraw, deny and project (“She’s overly sensitive” or “He’s hyper-critical”) which allows you to avoid the painful feeling of guilt arising from the caring and love that you actually feel… and also to avoid reparation, which would be healing.” Or, “You feel guilt over your rage and then you detach and shut down to avoid both the guilt and the rage.”
I just spent an entire session in which the patient was flooded with guilt because she’d injured a close friend. Her friend was hurt because my patient had cancelled a special celebration that her friend had planned for her (albeit with her friend’s compliant permission). My patient avoided her painful feeling of guilt (due to love) by projecting (“She was critical of me”; “She was overly sensitive”) and repressing the pain of guilt. The session involved delicate work but it led to some new awareness that took her back to how she defended as a child against being unfairly blamed and had been transferring her mother onto other people. She also saw how she mercilessly attacked herself. She was also able to reconnect with her love for her friend and saw the value of a simple apology. As she allowed the feeling of guilt to be experienced, she noticed a rise in anxiety over the sense of vulnerability over letting in how important she was to her friend… and how important her friend was to her. She realized that she had been afraid to similarly expose her own hurt feelings over past events when her friend had also treated her dismissively. This also opened a door to recognize her defenses of numbing, denial and minimization, which she did not want to carry forward.
Jon Frederickson said in his
blog, which I highly recommend: “When we experience our guilt, it makes us anxious. So we use defenses.” (We use defenses to avoid the painful feeling of guilt due to a sense of having wronged or hurt a loved one). I think it’s painful because there is caring feeling beneath it. Of course, healthy guilt is fully conscious and does not lead to defense but rather to reparation of the wrongdoing. Jon also said that ,”as a result of guilty feelings, the patient “narcissistically withdraws into self-punishment.” (a painful feeling leading to a defense).
Expanding on the triangle of conflict as used by Davanloo to guide our understanding of the patient’s psychodynamic process and also our interventions, I can now see having the anxiety corner of the triangle include all emotions that are defensive in nature and that arise to inhibit or shut down the experience of additional painful feeling and that also inhibit a healing or reparative process. This categorization would include the feelings of anxiety, shame, toxic forms of guilt, defensive rage ignited by projection (“She devalues me therefore I hate her”) and defensive weepiness (avoiding rage and complex feeling). These defensive affects would be distinguished from the tactical, repressive and regressive defenses, even though together they function as a system that separates us from self and other.
I’d like to recommend a wonderful book called Shame in the Therapy Hour, edited by Ronda Dearing and June Tangney. Some great excerpts below, which I believe provide further validation for understanding shame as an “inhibitory affect” that would reasonably fall on the anxiety pole and can also be understood as defensive in nature. Shame is referenced multiple times as an emotion with an inhibitory function (Schore – “sudden brake on excited arousal states”) and also an “emotion” that “inhibits speech and thought,” an experience of “shock and flooding,” and “likened to fear.” The accompanying self-attacking cognitions support the initial inhibiting shame response arising from being scorned and needing to appease. This hard wired response is of course self-perpetuated, like anxiety, without an attentive ego. The comparisons to guilt do not include unconscious guilt over rage, but only healthy guilt and remorse.
Judith Herman stated the following while referencing various researchers:”Shame can be likened to fear in many respects. Like fear, it is a fast-tracked physiological response that can overwhelm higher cortical functions. Like fear, it is also a social signal with characteristic facial and postural signs that can be recognized across cultures. The gaze aversion, bowed head and heightened behaviors of shame are similar to appeasement displays of social animals. It may serve a similar social function among human beings from an evolutionary point of view; shame may serve an adaptive function as a primary mechanism for regulating the individual’s relation both to primary attachment figures and to the social group. Like fear, shame is a biologically hard wired experience.” “Schore proposed that shame is mediated by the parasympathetic nervous system and serves as a sudden brake on excited arousal states.” “The subjective experience of shame is of an initial shock and flooding with painful emotion.” “Shame is a relatively wordless state in which speech and thought are inhibited. It is also an acutely self-conscious state. The person feels small, ridiculous and exposed. There is a wish to hide characteristically expressed by covering the face with the hand. The person wishes to ‘sink through the floor’ or crawl in a hole and die. Shame is always implicitly a relational experience.
From other articles in this book: “Because shame tends to arise in conjunction with cognitive appraisals of the self, it falls into the category of self-conscious emotion. This type of cognitive processing requires a certain level of developmental maturity, which explains why the propensity to experience shame is developed over time during early childhood rather than present from birth.” Shame is a “Powerful, ubiquitous emotion.”
Whereas shame is focused on the global self, guilt is focused on a specific action the person has committed. (Again, this doesn’t take into account the guilt that occurs over feelings like rage and love towards the same person). Shame is an acutely self-conscious state in which the self is divided between imaging the contemptuous viewpoint of hating the other and feeling the impact of the other’s scorn. By contrast, in guilt the self is unified. Feelings of guilt an seem to originate in the self. In shame the self is passive. Shame may be evoked by a sense of failure or disappointment or being the object of ridicule, rejection or rebuke. By contrast, in guilt the self is active; guilt is evoked by one’s own transgression. Shame is an acutley painful and disorganizing emotion. Guilt may be experienced without intense affect. Shame engenders a desire to hide, escape or lash out at the person in whose eyes one feels ashamed. By contrast, guilt engenders a desire to undo the offense, to make amends. Finally, shame is discharged in retored eye contact and shared, good humored laughter, whereas guilt is discharged in an act of reparation.” Lewis 1987
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