Shame hurts. If our shame is exposed, the pain can be unbearable. To save ourselves, we push shame away as fast as we can, covering for it with more tolerable states of being. These states of being are what we come to know of shame, both in ourselves and others. But they are compensations and collapses, masks and sleights of mind; they are not shame itself. What is shame itself? This book proposes that, despite its many disguises, shame can be understood as a unique, specific kind of interpersonal experience. This understanding of shame helps us see what’s behind the camouflage. It also helps us, as therapists, make interpersonal contact with our chronically shamed clients in ways that can ease their suffering.
In the first part of the book, I define the interpersonal experience of shame and I use this relational definition to bring coherence to diverse aspects of existing shame theory. All shame theory seeks to shed light on a shape-shifting phenomenon that lives in the dark. I’m grateful for the snapshots, documents, and storylines that shame theorists have contributed to date. Their theories become part of the new story I offer, one that seeks out shame in its most shadowy origins, before thought can frame it or words can speak it. I try to capture how early, nonverbal shame experience, unrepaired, takes on a furtive but powerful life of its own as chronic shame. I believe that this understanding may begin to do some justice to the havoc such shame wreaks in the lives of psychotherapy clients who have no name for what ails them.
I take a relational, psychodynamic approach to what has been written about the problem of shame, drawing on self-psychological, intersubjective, self-in-relation, interpersonal, and attachment theories. Most recently, relational theorists have linked neuroscience research results with processes of intensive psychotherapy. Affect Regulation Theory (ART) is one notable example of that linking work. I use Allan Schore’s ART notion of “right-brain therapy” as a guiding heuristic, a relational/neurobiological interpretation of pathology and therapy that helps me explain chronic shame and its treatment. Regulation theory also merges well with mentalization theory and dynamic systems theory, other aspects of the new science behind the art of relational psychotherapy.
But while I appreciate science-based explanations of how psychotherapy works, I hold them somewhat lightly. For I also believe, along with relational therapists of a more philosophical/hermeneutic bent, that all theory is interpretation. As a psychotherapist, I am not a scientist; I am a partner with clients in searching out the metaphors and meanings that make sense of their lives. I attend to the right-brain relational experiences clients hold in their bodies, emotions, and images. Likewise, I invite readers to join me in a rather right-brain approach to shame theory. Part I of this book defines and describes shame so that we can imagine what shame feels like from within many relational situations. The theory I offer is in service of helping our clients make personal emotional meaning of their unique, subjective shame experiences. It also highlights the vulnerable presence required of us if we are to connect viscerally and compassionately with the shame our clients can’t bear to feel.
Our troubled clients protect themselves from feeling chronic shame with a stunning variety of emotional symptoms and behaviors. We therapists have to be just as persistently adept at finding various ways to connect with their underlying trouble. We need to hold in mind many possibilities about how we might best connect with each chronically shamed client. So much depends on the forms and energies of the client’s self-protections, which often have become the style of the client’s personality. Part II of the book presents different ways we can respond therapeutically to our clients’ specific constructions of self around core chronic shame. No single “shame-busting” technique will do; instead, we learn how to move among our multiple therapist selves, all of them shame-savvy, to find the responses best suited to each client.
The book begins with stories from the lives of six clients. Their symptoms and life experiences are vastly different, and yet each struggles with shame. Reflecting on their diverse stories, I note the commonalities related to chronic shame. My frame for understanding these clients begins to emerge: Shame seems like a one-person problem, the negative self-feelings a person has because he or she believes “there’s something terribly wrong with me.” But in fact, shame is a relational problem; it has relational origins and it desperately needs relational attention, even though it is kept out of sight and out of the reach of relational contact.
The second chapter follows up these stories with relational theory about shame. I begin with a definition: Shame is an experience of one’s felt sense of self disintegrating in relation to a dysregulating other. When we are at our most vulnerable, our experience of being an integrated self depends on the emotional attunement or “regulation” we receive from those closest to us. A “dysregulating other” is someone close to us whose emotional responses leave us feeling fragmented instead.
What happens when a self is fragmented by shame? Forty years of theory about shame and the self offer some answers. Affect theory highlights a sudden shift in a pattern of neural firing. Those who define shame as emotion deepen our visceral sense of what it costs to suffer shame. Self psychologists track how the misattunements that produce chronic shame are transformed into self-objectifying thoughts and faulty self-images. Recent research clarifies the difference between the experience of guilt and the experience of shame.
All these accounts of shame fill out the picture of what it’s like for a person to live with shame, but none is a good match for my definition, which locates shame at a basic, early level of relational affective experience. Affect Regulation Theory offers the match I seek. Chapter 3 outlines what I find complementary and instructive in Allan Schore’s “right-brain therapy” for relationally traumatized clients. Schore’s ideas about shame also add scientific support to the idea that chronic shame has roots in early, repeated, right-brain experiences of affective dysregulation.
Chapter 4 addresses the question of how this early dysregulation becomes the established patterns of shame we see in our adult clients. I return to earlier shame theory, now reading it through an understanding of how affective dysregulation might in specific relational situations generate specific kinds of shame-patterns. The distress/deficit categories of attachment theory and self psychology prove most amenable to this kind of imaginative back-reading—and small wonder, since both bodies of theory are built around the idea that reliable attuned responsiveness creates healthy connection and healthy selves.
Holding in mind all this information about the developmental and relational roots of shame, how do we recognize chronic shame when it comes into the room with a client? Chapter 5 suggests we begin with what we feel. Our right brain attunes to right-brain trouble, and it will give us visceral, emotional signals if we pay attention. We can link what we feel with patterns we recognize from clinical experience and from shame literature; for example, perfectionists, procrastinators, and pleasers are often hiding chronic shame. We notice the aspects of our clients’ family-of-origin histories that left them misrecognized and emotionally isolated, and we are alert for signs of trauma, dissociation, and addiction.
The chapter ends with the reminder that above all, chronically shamed clients need right-brain connection with us, and this includes how we do assessment with them. With that note, we move from understanding chronic shame to treating chronic shame.
Chapter 6 outlines prerequisites for doing effective right-brain work with chronically shamed clients. The primary precondition is thorough self-awareness, the kind that usually takes in-depth psychotherapy to achieve. If we provide long-term psychotherapy for relationally traumatized clients and if we have any propensity to shame, our shame and our clients’ shame will inevitably become entangled. That’s why we must be self-reflective about our own shame, and not just once, but continually.
It also helps to do our homework. We read shame theory. We think about how to create non-shaming protocols for our practice. We reflect on the basic stance we take toward all clients and consider how it fits for shamed clients. We develop our capacities for mentalizing and mindfulness, and we aim for a stance that combines playfulness, acceptance, curiosity, and empathy.
Since shamed clients are quick to feel evaluated or misunderstood, we know that we have to begin gently, attending to shame subliminally. With some of them the word shame will never be spoken. But even if we should become able to work explicitly with our clients’ shame, we always have to begin with the subtle, implicit work of fostering right-brain connection with them. Chapter 7 tells us how to do that.
In brief, we offer our engaged emotional presence, trusting our clients’ right-brain selves to be listening to us long before they can respond. We hold what we know of our clients’ minds in our own minds, intuiting the relational/emotional narratives implicit in the limited stories our clients can tell. We nurture tendrils of healthy interpersonal need and trust as they emerge. We respond to clients in ways that link their experiences with their emotions. In all these ways we help clients develop the neural networks they need to connect more consciously with a felt sense of self, including memories, intentions, and emotions.
Chapter 8 begins with the principle that an autobiographical sense of self is a sign of right-brain integration. This felt coherence, grounded in visceral emotion, is not to be confused with a self-history created by left brain logical and linguistic processes. Relational/emotional narratives integrate right-brain neural networks because such stories can be felt as part of self, even while words facilitate the feelings and reflections.
We encourage our clients to move from disconnected narratives to felt narratives in many ways: we search with them for words that match feelings; we help them sustain in-the-moment mindful reflection; we spend hours with them inside the details of their attachment histories. What matters more than the story is the storyteller who experiences a more conscious, integrated sense of self while speaking to someone who listens deeply. Such integration is the opposite of shame, for shame is the dis-integration that happens when a self cannot find empathic recognition from an emotionally significant other.
And so it is that we can often do effective, self-integrative work with chronically shamed clients and never speak of shame. But even more often, clients need to speak directly about shame before they can challenge how it governs their lives. The dark emotional convictions of chronic shame will feel like truth until they are brought out into brighter spaces where compassionate acceptance is the rule. Chapter 9 suggests that whenever we can, we should help our clients give their shame the light and air it needs for healing.
A relationship of mutual connectedness may become a safe enough place for clients to speak of shame. Then we can offer clients bits of education about shame, helping them learn the ins and outs of how it works. We might revisit their family-of-origin narratives to understand better the roots of their chronic shame. Some clients find it especially helpful to let their shamed and shaming “parts of self” speak to us and to one another.
But there are always some clients who can’t afford to let themselves know about their chronic shame, even though it permeates their lives and relationships. Chapter 10 builds an understanding of how to be with them. I talk about dissociation, trauma, and the unconscious, and I share the story of my work with a highly dissociative client, a story that turns on the mutative power of making direct contact with her shame.
When clients are invested in keeping their shamed, vulnerable selves unknowable, we struggle to make genuine contact with them. We can’t touch their shame, but we can notice with them how each part of their carefully divided self-structure functions. We can hope that with sustained, patient understanding, their rigidities will soften, allowing them more real connection with other people and with their own vulnerabilities. Perhaps in time, and with continued connected support, they will even come to know something about the shamed, vulnerable self they have spent a lifetime banishing.
Often a client’s dissociated shame comes very close to the surface through its enactment in the therapy relationship. When the enactment is powerful and touches the therapist’s vulnerabilities, client and therapist may fall into a mutual enactment, one of the most difficult challenges a relational therapist can face. I end chapter 10 with Donnel Stern’s explanation of such enactments and of how they can end—not by insight, but by an unpredictable, unscripted change in affect and relatedness between partners. I note that “realization,” the kind of non-verbal knowing Stern believes can lead one out of enactment, is very much like the relational/emotional cognition Schore locates in the right brain. With this coda, I rest my right-brain case.
And yet there’s one more chapter. Chapter 11 asks the question, “Is there a cure for chronic shame?” The answer is complex. Therapy cannot erase the effects of childhood relational trauma; nevertheless, in relationship with us, our adult clients may experience profound positive changes in their patterns of implicit relational knowing. Furthermore, once our clients have named and faced their shame, we can work with them to reduce its power, offering them specific guidance as they seek to build shame-resilient lives.
First, they need help learning how to make authentic connections with important others in their lives. We encourage them to share emotions, negotiate needs, stop cycles of shame and blame, and discover the relief of guilt acknowledged and forgiven. Second, they need more authentic connection with themselves. We suggest that they build on the self-compassion and mindful self-awareness they have learned in therapy, and we celebrate with them the surprising new self-initiatives that emerge as the constrictions of their chronic shame ease.
As their dreams of perfection fade, shame-prone clients discover how to risk their hearts and their ambitions in the world. They find strength in being able to acknowledge failure, accept loss, and live with limits. As they end therapy, they accept that shame management will be a lifelong task. On saying good-bye, they may add, “I might need to call you sometime,” because they believe now that it’s okay to need help and to ask for it. This is a kind of transformation after all, and it is rooted in qualitative changes in our clients’ relationships with others, with self, and with their own shame. These are the changes we can hope for when we take a relational/neurobiological approach to understanding and treating chronic shame.