Surmounting Shame

As many of you know, I’ve had a particular interest in studying shame on a case-by-case basis for at least 15 years. Shame is now emerging from the shadows in the therapeutic world, as more therapists are writing and teaching on this topic and the empirical research is burgeoning. I’m excited to discuss and illustrate how I work with shame in two upcoming presentations featuring analysis of recorded clinical material:

Shame in Psychotherapy: Bringing Theory to Life

Susan Warshow, LCSW, LMFT

June 25-26 2015, Aarhus, Denmark

Information/Registration: sonne@aarhuspsykologerne.dk

Penetrating Defenses and Surmounting Shame

Susan Warshow and Jon Frederickson

Sept. 26-27 2015, Los Angeles, CA

Information/Registration: www.ceuregistration.com

Shame derives either from not being seen or being seen as unworthy… and left alone to crash about with emotions that can only be resolved through connection to a caring other. Shame is one of the most torturous emotions to experience and can be highly delicate to respond to therapeutically. It’s been my consistent observation that when the feeling of shame can be brought to immediate awareness, in a manner that evokes tenderness and compassion for self, there is noticeable relief from tension and anxiety. This includes both client and therapist shame.

I’ve had a number of exchanges with colleagues who hold the view that shame equals self-attack and that we want to help the client to turn against this self-punishing process, e.g. “Now you attack yourself with shame.” While there is often self-devaluation involved with shame and there is unquestionable efficacy to this theory, we might also ask, “Who is doing the devaluing?” There is evidence that this collapse or retraction of self can occur in infancy and throughout life as an implicit state of being with non-verbal manifestations.

Allan Schore describes a “surface, verbal, conscious, analytic explicit self vs. a deeper nonverbal, non-conscious, holistic, emotional corporeal implicit self.” He states, “The ongoing paradigm shift from the explicit cognitive to the implicit affective realm is driven by both new experimental data on emotional processes and updated clinical models for working with affective systems.”  A defenseless child or infant incorporates shame as a bodily experience and body memory, e.g. an instant introjection of the scathing or disgusted expression on another’s face, especially when the experience is repetitive. The verbal conceptualization is a secondary process. For me, understanding shame through this lens captures the complexity and the relational component to the shame experience more completely than the concept of “self attack.”

The first tape that I presented at an International Experiential Dynamic Therapy Association conference showed a painful, painstaking process in which the male client was trying to tell me with great difficulty about a shameful, self-defiling behavior. Dr. Robert Neborsky told me that he felt a change moment occurred when I expressed unscripted, deeply felt, spontaneous sadness over his self-harming actions. A wordless world of feeling was communicated through the eyes, an antidote to the unseeing eyes of his mother. These moments form new body memories.

Communication experts have long recommended we not use “you messages” because “you” messages have a tendency to make people more defensive. Sometimes when we say, “Now you attack yourself with shame,” our client may respond with “Not only am I ashamed of my failure but now I am also ashamed of shaming and attacking myself.” There are many ways to help a client to transcend shame states both non-verbally and verbally, especially with careful attention to language and prosody. I will illustrate this process with video and lecture when I speak on this topic in more depth in my upcoming presentations on shame. How about using our creativity to think about more shame sensitive ways to comment on shame? E.g, “How sad this sense of unworthiness seeped into your body from the time you were a small boy, and now it feels like a real part of you. Someone must have passed this on to you but have you considered you no longer have to carry this raggedy robe around with you for the rest of your life?” Or a shorter version: “So would you say that we’re seeing that learned shame mechanism attacking you again?” “How do you feel about this? How would you want to respond to it?”

I previously mentioned therapist shame, which can be just as virulent as the client’s. I’ve often been asked to show my mistakes and fumbles in my video recorded material and to show sessions that didn’t work. The reason for this is intuitively obvious. We want reassurance that we are not alone with our struggles to perform as therapists and also to feel hopeful is spite of our shortcomings.

In my upcoming Denmark presentation, I decided to show a mix of older and newer work and to explore how my work has developed over the years as I sought to make my interventions more shame-sensitive. As I watched some of my earlier work, my language and tone actually made me cringe a bit. Sometimes even more than a bit. There might be a rushed quality to my voice, when the client had just shared something that was particularly embarrassing for him… and my mind was recapping something in a very left brained, clipped kind of way… “So what I hear you saying is…” Fortunately, those particular clients looked past my moments of flawed embodied attunement and improved anyway. But that wasn’t always true. Working with shame sensitivity has increased my therapeutic results.

Often, those times when we’re off the mark occur because our own shame avoidance, driven by the quest to “do the right thing,” drives us out of the moment and into our heads and agendas, missing important cues that are right in front of us. Recently I did a supervision session with a very talented therapist, and because she had a particular agenda in mind, she sped past the client’s mention of feelings of guilt. Our performance expectations cause us to speed up, when what is really helpful is to slow down.

We all know that therapists are just as human and vulnerable as the next person, though this often surprises people. Not only do others have higher expectations of us, but we often do as well. Shame can attack quite viciously when we lose a client, get lost in a session or experience harsh devaluation from a client. Therapist shame is also often activated when we are exposed to the work of some of the true geniuses in our field. One aspect of their greatness may be that they do what only they can do… be themselves. Their personality, even quirkiness and idiosyncrasies, sometimes comes through in dramatic and creative ways. They may say something we couldn’t imagine saying. Or they do something that would never seem natural coming from us. While we can learn great principles from them, there are some things we cannot reproduce effectively because it wouldn’t be us. Their vocabulary isn’t ours, their inflection is different and the way they would express something may not work for us.

This does not mean we shouldn’t study the skill set of these great teachers carefully, but we should really try to refrain from pushing ourselves to mimic them. Often theoretical breakthroughs become codified into a system from which one dare not deviate, as the system becomes the gold standard and all else is lacking. When we hold this view, it only activates our own shame and quashes our unique creativity. Shame and creativity are not likely to co-exist.

I can tell you from my own experience that it is possible to reverse our shame-driven tendencies through conscious awareness and having the intention to surmount them. We need to remember again and again that nothing is more valuable than being authentic and staying present in the moment. With these operating, we heighten our perceptiveness and release our creative intuition, thereby elevating our work.

When we move into a space of truly not requiring anything from our clients, including their “growth” or approval of our work, an exciting new space for unlimited exploration emerges. We can begin to enjoy and appreciate every tiny step towards true connection and self-disclosure, such as when a client can reflect upon his resistance in a new way or reveals annoyance with us for the first time… all can be seen and commented upon as hopeful developments. We no longer value only the big unlockings but also the little unlockings of intimacy, and this will create more satisfaction in our work. While I will still encourage the option to delve deeper into underlying feeling, as an alternative to learned restraints, I will no longer attach an implication of failure about the choices a client makes. They are simply choices and no one needs to be judged because of them.

A group of therapists were having a discussion inspired by Allan Schore’s recent evocative presentation at a UCLA conference, which he entitled “The Right Brain in Therapeutic Creativity, Connection, and Play.” They mentioned Big C and little c creativity, which I supposed was like a Van Gogh painting compared to one of my flower arrangements. While there is obvious validity in the distinction, something in me rebelled against linking the words “little” and “creativity,” as all creativity, including a therapist’s creativity, has a value that cannot be quantified. To do so can move us towards shame, and the following process that is beautifully described by Jean Baker Miller, MD, founder of the Jean Baker Miller Training Institute at the Stone Center, may become less likely:

“Most important of all, the therapist needs to learn how to participate in the therapy relationship in such a way that she facilitates “movement in relationship.” How does she do this? If she is really present and authentic, she will be moved, i.e. feel with the patient’s expression of her experience. If the therapist can make it known that she is moved, the patient will be moved, i.e. feel with the therapist feeling with her. The patient, thus, has the very valuable chance to know that her thoughts and feelings do reach another person, do matter and can be part of a mutual experience (Miller and Stiver, 1997). We think that this is the key source of change in therapy. It is so important because the basic trouble has been the disconnections in which the patient has little or no possibility of having an authentic effect on the disconnecting relationship.”

I’d like to share a bit of a transcript from a dialogue with a client that would not have transpired had either of us been in a state of shame or restricted receptivity to the moment. During treatment, she had shared with me her rage at God for apparently abandoning her almost at birth, leading to a state of despair. She’d had a violent, alcoholic father and a narcissistic, absent mother. After working with her rage towards her parents, something moved me to also explore her rage towards God, an avenue that is sometimes discouraged in the traditional therapeutic community. However, my interest helped her to have the experience of having all parts of her seen and held, which led to the following exchange:

Pt: I’m so grateful that someone cares…

Th: Me.

Pt: You.

Th: Me. Yes.

Pt: Somebody wants to help.

Th: Thank you so much. That’s such a beautiful feeling. Gratitude.

Pt: Thank you.

Th: You are so welcome. It’s such a privilege for me. You’re so worth helping. It’s striking isn’t it? This is another force. You talked about your rage at God. “How could God let this happen?” And now we see that God lets this happen too… would you say?

Pt: Yeah.

Th: I feel like the caring that I feel…(the caring) that comes through me…is very big. I feel it very big towards you. And I also feel like it’s coming through me…like it’s me, and its bigger than me. How does it feel to hear me say that?

Pt: It feels believable. I feel that too. Like if I look in your eyes, I don’t see just you. I see…or I feel a very—like a timeless sense of caring, eternal compassion and connection.

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