How To Treat Shame: A Guide For Psychotherapists

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Shame treatment is a very difficult and painstaking process. What are the difficulties? First, customers don't recognize their shame well. Second: customers tend to hide their embarrassed parts. Third: shame healing is a very slow process. Despite the difficulties, shame is a treatable condition.

Psychotherapist Ronald Potter-Efron identifies five stages of working with shame.

1. Create a safe environment for the client to reveal their shame

Nothing useful will happen until a relationship of trust is established between the client and the therapist. As a rule, at the first stages of therapy, the client presents topics that are not the most embarrassing for him.

2. Accept this person with his shame

When a client shares embarrassing information, the therapist must refrain from trying to talk them out of the shame. It is important for the therapist to be able to accept the client in his shame, as if saying: "Yes, I see your shame and what you are ashamed of, but I will not leave you with you."

3. Investigate the sources of shame

The purpose of this stage is to help the client understand that their shame is caused by the attitudes of others, and not by the actual situation.

4. Encourage the client to question his self-image, check the validity of embarrassing messages

The previous stages are important in order for the client to turn to the image of himself. What is he really like? We hope that the client will start to research it himself. It is the therapist's job to maintain this tendency and to question the validity of the messages the client has received from other people. For example, How did your mother know that you are so terrible? I see nothing wrong with you. And you?

5. Support changes in self-image that build healthy pride

The client ceases to perceive himself as an irreparably defective person. The idea is that he is "good enough" - this leads to the formation of realistic pride. This is a slow process. So sometimes the client will fall back into shame. The task of the therapist is to maintain a healthy part of the personality.

An example of working with shame by Ronald Potter-Efron from his work "Shame, Guilt and Alcoholism"

“Linda is the forty-year-old daughter of an alcoholic father and a“crazy”and physically abusive mother. As a child, she was regularly beaten and humiliated. She has become so deeply ashamed that she feels helpless in changing her current life with her chemically dependent husband. After six months of therapy, she progressed to the point where she was able to join the therapy group.

One introductory exercise I have used is called "The Mask". In this exercise, clients are first asked to paint their masks - the images they want others to see. And then the person under the mask. As soon as Linda drew this person, she became very excited and suddenly left the room, running to the toilet with a bout of nausea. She had the courage to return, but declined my invitation to share what happened with the group.

Stage one: security and disclosure

Linda was in a new environment in which she felt too vulnerable to reveal her shame. She needed confirmation that I would not try to force her to talk about it now. I did it non-verbally, but then suggested that she stay after the session because I didn't want her to leave so scared and ashamed.

In private, Linda showed me what had happened: the "real" person under her mask spontaneously evolved into a horned satanic figure. Linda viewed herself as the devil, an image that characterizes many ashamed individuals.

Stage two: acceptance

Linda was shocked because she didn’t expect her shame to surface so quickly and with such force. She also recognized this inner image; he felt completely correct and familiar, although she didn't know why. She had to explain to me specifically why she felt like Satan, corrupted and inhuman. My role during this phase was to encourage her openness, not allowing her to despise herself so much that I could lose contact with her. I had to contain a strong urge to lessen our discomfort by rushing to her aid before we actually face her shame.

Stage three: research

I asked out loud who could tell Linda that she was the devil, who attached the horns to her head? To my surprise, Linda immediately remembered what she had been supplanting for thirty years; for several years before and after puberty, her mother, beating her, repeatedly called her the devil's offspring. Unable to resist, she has incorporated this confidence into the core of her identity, displacing its source. She could not doubt this, because this message was not available to her on a conscious level.

Stage four: questions and doubts

Fortunately, Linda has worked long enough on the concept of herself that she can begin to doubt this image for herself. Part of her was angry and still didn't fully accept that she was terrible. Encouraged by me, she allowed me to cross out the devil's horns on her head, looked at the remaining image of a normal woman and burst into tears of relief. She realized that she "swallowed" someone else's definition of herself, and that she can now reject this image and replace it with a positive one.

Stage five: approval

Then I asked Linda to draw the new person she sees. In her drawing there was a strong, intelligent and caring woman, looking directly and proudly at the viewer. We talked about how she found this new person not only now, but also a few sessions ago in therapy, and how this new woman has already changed her life with her husband and family."

Important: The stages can be passed both over a long time, and within one session. In the early stages, the challenge is to establish contact and develop trust. If the therapist forces things to happen, the client resists. He will feel that the therapist does not understand him and cannot appreciate the depth of his pain. You can explore the client's attitudes as long as the therapist has enough patience for it. Meeting and forming a healthy “I” of the client is impossible until the client accepts the therapist as a significant figure in his life. Potter-Efron Council: "The deeper the shame, the more the client should trust the therapist."