Shame can be a hindrance or a healing agent in psychotherapy. It is incumbent upon the therapist to recognize shame in the client, but, it is equally important to recognize it in ourselves. While our work might start with the client’s shame, we will inevitably be confronted by our own.
Dearing and Price-Tangney (2011) define therapist shame as “an intense and enduring reaction to a threat to the therapist’s sense of identity that consists of an exposure of the therapist’s physical, emotional, or intellectual defects that occurs in the context of psychotherapy” (p.308). It is "more intense and extreme than embarrassment" (p.309) because it is about the self "in contrast to guilt's focus on behavior" (p.309). They propose a Critical Events Model of Supervision (CES) wherein "the supervisor helps the supervisee acknowledge feeling shamed"(p.314) by an experience with a client and "facilitates the exploration of the supervisee's feelings" (p.312).
DeYoung (2015) states: '"therapists have to do their own work"' (p.77). In other words, therapists need to confront and deal with our feelings of shame so that when it is triggered by clients "we need to be able to feel it, name it, and find where it lives in us" (p.77).
To mitigate against shame as a hindrance in therapy, I recommend that therapists both engage in supervision and in their own therapy to do the work of uncovering their relationship with shame, learn who we are best suited to work with, and engage in education and training that develops increased competence.
Therapists and clients will go to great lengths to avoid feeling shame. Therefore, it is the therapist who must be looking for it in the consultation room. Otherwise, a “mutual collusion” between client and therapist is likely- an unspoken agreement to avoid considering shame and the “intersubjective reverberation” (Morrison, 2008, p.68) that follows.
In adult treatment, when childhood trauma emerges, inevitably, shame will be present. Shameful feelings reemerge in the client related to asking for help because of not having received needed help in childhood from one’s caretaker (Kilborne, 1999, p.385). Therapists want to protect themselves and their clients from feeling ashamed. Clients and therapists can find themselves in the throes of assessing the others’ capacities for bearing shame. Once uncovered, shame creates anxiety, which, in turn, triggers reactions. Clients feel shame for feeling defective or different, for not living up to ideals, disappointing others, being unable to love, not knowing themselves, and for being manipulative (Kilborne, 2007, p.10). And, so do therapists. Ultimately, therapy is hindered or deepened by the therapist’s ability to tolerate shame.
In my years of clinical practice, I have recognized the experience of being ignored, devalued, and powerless when sitting with certain clients. I want to protect myself from the feeling that I am doing something “wrong” when helping clients peel back painful layers. I want to be the soother and not the one coaxing out the pain. Noticing these feelings is my clue that severe shame is present and the client is suffering in ways that may be beyond his or her own awareness.
Davies explains the therapist’s experiences as a “countertransferential pitfall in which the analyst comes to feel so guilty about evoking the patient’s horrendous memories of early abuse and betrayal” (2004, p.717). She explains that the therapist “must be both the object of the patient’s transferential rage over abuse, abandonment, and betrayal, as well as the one who helps the patient contain, soothe, modulate, and ultimately come to terms with such experiences” (2004, p.717). Therefore, it is when we are aware of our own shame dynamics that we can be grounded in our identity, and not need to rely on omnipotent defenses (Kilborne, 2007, p.10). Clinicians need to be wary of feeling that we are the expert who does not experience shame.
Therapists can benefit from keeping in mind the developmental research of Allan Schore who notes that the practicing child enters a challenging scenario with the caregiver “in a hyperstimulated, elated, grandiose, narcissistically charged state of heightened arousal” (Schore, 1991, p.194). The child is anticipating the caregiver will share in his affect state, but instead, he is met with the unexpected experience of misattunement which triggers a sudden deflation (p.194). When there is no interpersonal repair, the practicing child internalizes this as “the prototype of shame experiences” (p.194).
Schore’s research informs the therapist’s need to work directly with experiences of misattunement between ourselves and the client. For example, it can feel helpful to the client when I attempt to be transparent about the moments when I have missed the mark and not understood his or her experience accurately. I own that I have missed them or gotten something wrong, rather than indicating that it is up to them to try harder. This is the repair that was sorely missing in childhood and greatly needed in adulthood.
Lastly, therapists would do well to listen to the sage words of Andrew P. Morrison who writes: “coming to terms – with accomplishments, with satisfactions, with disappointments [is] a goal that signifies wisdom" (2008, p. 80).
References
Davies, J.M. (2004). Whose bad objects are we anyway? Repetition and our elusive
love affair with evil. Psychoanalytic Dialogues. 14 (6):711-732.
Dearing, Ronda L. and Price Tagney, June. (2011). Shame in the therapy hour. Washington D.C.: American Psychological Association.
DeYoung, P.A. (2015). Understanding and treating chronic shame: A relational/neurobiological approach. New York: Routledge.
Kilborne, B. (1999). When trauma strikes the soul: shame, splitting, and psychic pain.
American Journal of Psychoanalysis, 59, 385-402.
Kilborne, B. (2007). The importance of shame in clinical work. The Round Robin.
Section I: Volume XXII, No.2.
Morrison, A. P. (2008). The analyst’s shame. Contemporary Psychoanalysis, 44, 65-82.
Schore, A.N. (1991). Early superego development: The emergence of shame and narcissistic affect regulation in the practicing period. Psychoanalytic
Contemporary Thought, 14, 187-250.