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The therapist’s ten commandments: “First – Do not shame”

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Shame

A while ago I talked to a depressed client who visited my office for the first time. It was a standard consultation, aimed at getting to know each other better and to collect initial data. I learned among others that this was his first consultation ever with a shrink, so a part of our conversation dealt with, as is usual in such situations, client’s expectations and general rules for the treatment. After an hour or so the client was on his way out of the office and I followed him to the door. With his hand on the doorknob he hesitated, turned back towards me and said: “You know, on the way to you I was afraid of only one thing. I was afraid of hearing “pull yourself together!”…

What did his words mean? Well, many people who enter psychotherapy experience high level of shame and I interpreted my client’s words as a sign of relief of not being shamed by me – something he rather expected. A series of following consultations revealed his life-long history of being shamed by people with whom he had important relations.

Although shame is a very common psychological phenomenon, it is not given very much attention in our culture, at least as I perceive it. We like to talk about love, anxiety, jealousy, hate, vengeance or grief. But the topic of shame is often like “an elephant in the room”. Perhaps it’s shameful to discuss shame?… Anyway, one thing is crystal clear to me: without understanding the phenomenon of shame we cannot understand the way people behave in social interactions, so the topic is extremely important.

Shame is a very complex topic and may be discussed from multiple angles, not only as an emotion. It has its biological roots, neurophysiological mechanisms, interpersonal functions, cognitive and behavioral components and cultural dimensions. A single blog post does not have enough place for such a broad scope. In brief, the tendency to experience shame, called shame-proneness, usually originates from earlier experiences of being shamed by others, especially significant ones, such as parents, teachers, peers, partners. Those significant relations shape the way people relate to themselves and to others later in their lives. Even if people have forgotten early shameful experiences, they will still impact their interpersonal behaviors.

Shame may also be derived. Culture, society, family and different groups, to which we belong, provide us with clear hints on what kind of personal characteristics are undesirable and disapproved. If we find ourselves matching the criteria of disapproval, we may become ashamed of being who we are, even if we never met direct criticism or rejection. Some people are for instance ashamed of sexual preferences even if they have never been directly shamed by others. They have just learned that their sexual desires are “wrong” and condemned by society. The same mechanism underlies mental health stigma: many people who experience psychological problems never seek help because they witnessed negative attitudes towards other people with mental disorders.

Shame has many sources and, in fact, anything that is perceived as a potential cause of social disapproval may elicit shame. For that reason, the list of possible shame-eliciting cues for our clients is practically endless. And here is the point: we can easily create the new ones during therapy, even being unaware of doing so.

There are several publications elaborating on the topic of shame and you can easily google something interesting about it on the internet. If you want to dive deeper into the subject, I recommend the book “Shame: Interpersonal Behavior, Psychology, and Culture” by Gilbert and Adrews. As it is impossible to discuss the topic of shame in depth in a single blog post, I won’t even try to do this, but one of the subtopics is especially important and worth mentioning here: the distinction between shame and guilt.

Brene Brown, made a nice distinction between shame and guilt, pointing out that guilt is linked to behavior, while shame is linked to Self. While experiencing guilt, we think “I did something bad”, whereas while experiencing shame we think “I am bad”. Guilt is about my actions in my own eyes, while shame is about me in the eyes of others. Both shame and guilt are unpleasant, but research has show that only shame is strongly linked to psychopathology (Hastings et al., 2002; Fergus et al., 2010; Kim et al., 2011).

Shame is problematic in multiple ways.
First, being a social emotion, shame regulates social hierarchy and protects societies and groups from rule-breaking behaviors. In other words, shame protects the group from individuals, of course at the expense of individuals. Shame-proneness increases conformity, vulnerability to rejection, pliancy and susceptibility to group influence. In groups with a hierarchy based on popularity, shaming mechanisms give group leaders very strong control over behavior of group members. Stories of people who survived (or not survived) membership in religious cults illustrate how far group control may reach.

The power of shame has evolutionary roots, as the fear of being excluded from the tribe developed as one of the core mechanisms granting survival to our species. At the dawn of humanity, we lived in small groups moving through the African savannah, without any chances of survival if left alone. The fear of being excluded from the tribe and left behind still underlies a large part of human social motivation.

Being related to the self, shame is also toxic for our mental health through the changes it makes in the way we relate to ourselves. After being shamed and rejected by others, people may start to see themselves as the main cause of their misery in interpersonal relations. Thus they may turn against themselves with self-hate and self-attacking. This leads sometimes to heavy forms of psychopathology and to living extremely self-destructive lives.

Knowing all that, do we take into account shame and self-criticism in our therapeutic work? What kind of context do we create for treatment? Do we create a safe space in which our clients can feel secure from being judged and blamed by others and gradually adapt a more gentle and kind attitude toward themselves?

We all learn who we are through the lenses of the important others. Sometimes this view is extremely devaluating, harsh, unfair or even absurd. Therapy gives an opportunity to change it. And the way the therapist looks at the client has a powerful impact because of the therapist’s social role and status. So, what do our clients see looking at themselves through our lenses? How does the language we use to describe their problems impact that view? Does it boost self-respect or self-pity and shame?

Let’s have a look at the language used by therapists. Many terms we use to describe psychological problems have clear pejorative connotations. For instance, what do people hear when we talk about inflexibility? What is the word associated with? Or the word “avoidance”? How does it sound to be avoidant?

How about the concept of “giving up your values for avoidance”? What kind of person can be described this way? How about concluding that it applies to you after having read a text on a website, or listened to a trainer or lecturer? Would it increase your self-acceptance and self-respect?

In my clinical practice, I have met many clients who learned earlier in therapy that “they cause their own problems”, sometimes by “avoidance”, sometimes by “irrational beliefs”. Does it sound less critical and less blaming than “chemical imbalance” in the brain?

People may respond to shame in various ways. Some will franticly try to regain acceptance from others by submissive and pliant behavior. Some will withdraw from relation, hide and isolate. Some will adapt a more defensive stance and try to use aggression to neutralize the threat. This is what people often do in their social interactions while protecting themselves from shame and this is what you will see in your office when clients feel shamed, blamed and criticized.

But first of all, clients who are hypersensitive to shaming and criticism may easily get new fuel for their self-criticism after deriving blame from the therapist’s words. Then therapy would by like an attempt to treat burns by setting fire on them.

The role shame may play in treatment has been demonstrated among others in the study conducted by Randles and Tracy (Randles & Tracy, 2013). Subjects were recovering individuals attending alcoholics anonymous. They were videorecorded while responding to the question: “Describe the last time you drank and felt badly about it.” Those who displayed nonverbal signs of shame had greater relapse rate, the relapse was more severe, and over the next months their health declined more than the health of individuals displaying fewer signs of shame.

There are various ways of talking about psychological problems. Some of them have a bigger blaming potential than others. Intended or unintended, the impact they have on clients may be destructive. So, I would suggest to always look critically at models and metaphors used in communicating with clients, not only in a session but also when communication goes through indirect channels, such as blogs, public talks and popular articles. Quoting Hippocrates: “Primo non nocere” (“First, do not harm”)

One of my supervisees asked me recently “If you could write the therapist’s ten commandments, what would you put there?”. I do not have the whole list yet, but certainly number one would sound: “Do not shame”.

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Further readings:

Fergus, T. A., Valentiner, D. P., McGrath, P. B., & Jencius, S. (2010). Shame-and guilt-proneness: Relationships with anxiety disorder symptoms in a clinical sample. Journal of anxiety disorders, 24(8), 811-815.

Gilbert, P., & Andrews, B. (1998). Shame. Shame: Interpersonal Behavior, Psychopathology, and Culture: Interpersonal Behavior, Psychopathology, and Culture,

Hastings, M. E., Northman, L. M., & Tangney, J. P. (2002). Shame, guilt, and suicide. In Suicide Science (pp. 67-79). Springer US.

Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: a meta-analytic review. Psychological bulletin, 137(1), 68.

Randles, D., & Tracy, J. L. (2013). Nonverbal displays of shame predict relapse and declining health in recovering alcoholics. Clinical Psychological Science, 1(2), 149-155.

CC BY-NC-ND 4.0 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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About the Author:

licensed clinical psychologist, psychotherapist, researcher, peer-reviewed ACT trainer

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Comments

  1. veerabalaji veeraswamy  April 24, 2016

    Hi Stan ,

    I was interested in shame during my graduation years. But later forgot the issue. Thanks for bringing it back ☺.

    I would suggest John Bradshaw ‘s book on Shame titled Healing the shame that binds you.

    reply
  2. hibahealthwiseHiba  April 26, 2016

    Thanks for sharing this post in the ACBS community – I am just starting out as a therapist and am fascinated by the place of shame, which, as you write is always there. Even though I have done a lot of reading on shame, particularly the work of Brené Brown, I find that shame feels very ‘slippery’, very hard to identify and name for both myself and my clients.

    reply
  3. Christina Jones  April 30, 2016

    I published an article in the Journal of Offender Rehabilitation titled “Why Persistent Offenders Cannot be Shamed into Behaving”. I also concluded that “do not (purposely) shame” is the rule that should be followed – though I felt that it may be nearly impossible to help some people change without inadvertently triggering shame. Thanks for the article!

    reply
  4. André Porto  December 16, 2017

    Olá, gostei muito da distinção feita entre culpa e vergonha. Bem como da reflexão de qual pode ser o impacto de nossa linguagem enquanto terapeutas. Parabéns.

    I really liked the distinction made between guilt and shame. As well as quality reflection can be the impact of our language as therapists. Congratulations

    reply

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