Is there a cure for chronic shame? As a psychotherapist, I would like to say to my clients, Yes, absolutely. We can beat this thing! As a person who has struggled to understand and integrate my own chronic shame, I would love to answer, Yes, I’m over it. To be honest, however, I have to say, No, I don’t think chronic shame can be cured. Long-term relational trauma leaves our psyches indelibly marked. Even with the best psychotherapy, we don’t just get over a lifetime of wondering whether we really matter to those closest to us or whether we can be enough for those to whom we do matter. We don’t radically reconfigure a personality built around anxious self-protection.
On the other hand, coming to terms with chronic shame can make life far more bearable than if we just try to soldier on, oblivious. “Bearable” is putting it cautiously. I’ve seen people emerge from chronic states of shame into states of consistent well-being that include pleasure and even joy. That’s because although shame can’t be cured, the painful effects of shame can be reduced in our daily lives. Such shame reduction happens both inside and outside of therapy.
How to ease shame within the process of therapy is the gist of this book. The key is a relationship between client and therapist that’s the antithesis of a shaming relationship. Our attuned responsiveness encourages clients to reconnect with relational needs and intensities of feelings long denied. Our empathic curiosity invites them to open up to the emotional story of their relational lives with others. Our compassionate acceptance of all of their experience makes space where even shame itself can be given light and air. And perhaps the most powerful antidote we offer our clients is our willingness to acknowledge and work through the shame that comes up between us and them in therapy.
If our clients lead lives of chronic shame, our relationship with them is our point of leverage against their suffering. But they see us for only an hour or two a week, and the rest of the time they live their lives in the world, outside of therapy. Will they feel less shame out there, too? When therapy ends, as it must, their lives will go on. Will their shame continue to be eased?
Our clients leave the therapy room with new memories, having had new experiences. When therapy works, they take with them expanded capacities to be in relationship with us and with themselves. We hope that the changes begun with us will spread organically to new growth outside of therapy. And in fact, often we do more than hope. To extend the metaphor, we don’t just trust the wind and rain; we plant some chosen seeds and nurture them. Though it may seem outside the purview of a psychodynamic practice, we give our chronically shamed clients certain kinds of practical help so that they can have a better chance at lifetime shame reduction.
Many of our chronically shamed clients have been disappointed by previous therapy, and for good reason: the therapy didn’t help them with their shame. Therapists and clients often side-step the shame they enact with each other. No one wants to feel the relational devastation that lies at the heart of shame. Instead, therapists encourage shamed clients to work on their internal feelings of being wrong, ugly, inadequate, or worthless—on the effects, not the cause, of what’s wrong. The relational essence of shame is not addressed. Sadly, when such “working on shame” fails to produce lasting change, a client may feel shame about this failure, too.
We intend to get to the root of shame with our clients. Yet we still need to talk with them about “shame reduction” instead of “cure.” We know that even when our clients have been able to connect with the relational pain of the shame they have suffered, they won’t find themselves pain-free or shame-free. This will disappoint them. Even as they come to feel more connected with us and more solid in themselves, these clients will still long for a more transformative therapy, and they may protest bitterly the difficult feelings that still plague them, the bad thoughts that come back to haunt them on vulnerable days.
We understand their anger as part of their grief about irrevocable losses. They will never know the naïve well-being of secure attachment; they can’t go back in time to change what happened. We also understand that their idea of cure has been constructed by their shame. From the perspective of a chronically shamed self, cure looks like knowing at last that there’s nothing wrong with you. When cured, you will be finally perfect, and perfectly loved. Shame-prone people wouldn’t say that fantasy out loud. They “know” better. But, as they may tell you if you’re the latest in a series of therapists they’ve seen, shame-prone people are easy marks for promises of transformation. They really do hope that there’s a beautiful authentic self hidden inside, and that when they find that self, they will be able to dump their shame-riddled inauthentic self at the side of the road.
To keep from playing into this fantasy, I don’t talk with clients about transformation through therapy. I know that it’s not in our best interests, my clients’ and mine, to imagine that our work will result in total transformative healing or the realization of a finally authentic self. For all of us, the changes we experience in therapy—as in life—are genuine and they matter. Yet, as we continue to change, we also remain the same persons that we were, if older, wiser, less troubled, and more connected with ourselves and others.
We hope not for cure but for shame reduction because shame is not only tenacious, it has become part of our being. Even if we manage to get the help we need to be able to face and feel our shame, we can’t dump our shame-riddled self at the side of the road. Like it or not, that self remains an essential part of who we are. In the language of multiple selves, that enduring self needs not to be ostracized but to be understood and befriended. In the language of interpersonal neurobiology: we can ameliorate the effects of relational trauma on the brain, but we can’t erase them.1
Neural plasticity means that new information, new neural firing, can help the brain heal itself. But as the literature on recovery from stroke and traumatic brain injury illustrates, building new neural pathways and networks takes long, hard work.2 In the case of relational trauma, the new pathways don’t replace networks that have been destroyed. Instead, new pathways connect what’s been dissociated and open up what’s been blocked or stunted. Then inner and interpersonal connection and comfort become possible, soothing even old hurts. Instead of experiencing the shame of disintegrating in relation to dysregulating others, one can experience integration—even of one’s shamed self—within empathic relationships with others and with oneself. But even for these changes to become possible, neurons need to fire together many times before they begin to wire together, and new capacities need to be used consistently to keep them viable.
For many clients this may be the image that best explains why “there ain’t no cure for shame.” We can’t wipe clean our internal operating system and start over. But we can keep giving the emotional/relational side of our brains chances to take in new information and process it differently. I may say just that to a client who knows what shame has cost him and wonders, “Where do I go from here?” He needs experiences that will continually create new synaptic connections that supersede and reconfigure the old.
In more relational language, he needs ongoing repetitions of interpersonal contact that feel much more safe, responsive, and validating than what his early wiring leads him to expect. And he needs just as many novel, positive experiences of being with himself. In this context, the context of relationship, “authentic” is a helpful word: he needs to learn how to be in authentic relationships with others and with himself. That sums up the two categories of practical help our chronically shamed clients need most from us as they attempt to reduce the power of shame in their daily lives.
All of our chronically shamed clients have trouble where self meets other. For some the trouble is obvious, whether they come off as self-effacing or arrogant. For others, who hide their shame behind perfection or who live a psychologically split existence, the trouble between self and the world is far from obvious. But for all of them, whatever their protective self-organizations, their shame comes from the same basic experience: something went badly and consistently wrong in their early connection with others. And so right at the point where self and other might connect, the problem persists. In Judith Jordan’s words, “Shame is most importantly a felt sense of unworthiness to be in connection, a deep sense of unlovability, with the ongoing awareness of how very much one wants to connect with others.”3
As clients become able to face their deep sense of unlovability and to link it with their unmet longings to be in connection, they will also begin to feel their loneliness here and now. As I said in the very first chapter, this is the one thing that chronically shamed clients have in common: they lead a profoundly lonely existence, often more lonely than they know, since it’s all they have ever known.
Clients who believe they are unlovable are lonely not because there are no people in their lives (we rarely see hermits in therapy), but because their relationships with others are inauthentic. These clients may seem to be present, they may even seem to have many friends, but in the relational paradox the Stone Center theorists highlight, they stay in a semblance of connection by keeping most of who they are out of connection. We can help them notice this pattern, and we can also help them learn to do connection differently—not only with us, but also with the “real people” in their lives.
For many of our clients, a first step in becoming more authentic in relationships is learning how to share their emotions with someone close to them. We can help that process along in simple, direct ways. For example, a client may have figured out that when her best friend Jane goes on and on about next summer’s wedding plans, she feels envious at first and then hurt and distant. When we’re confident our client feels our empathy with her, we might ask, “Have you ever thought about talking to Jane about that? What do you think might happen if you did?” That’s when we hear our client’s conviction that her feelings will only cause trouble in the relationship. She needs to keep her hurt to herself if she wants to keep Jane as a friend.
We can agree with our client that maybe Jane can’t listen. Some friends can’t. “On the other hand,” we might say, “it seems possible—given how much you like Jane and given your history of not being heard as a kid—that you’re putting some convictions from your past on your present. We all do that; it’s a natural thing to do. But when those old beliefs make you sad and shut you down, it seems worth it to wonder if maybe they don’t really fit. What if Jane could actually understand how you feel? What if your brain is doing an old thing with a new situation, and it could do something new? Do you think, with Jane, it’s worth trying something new?”
Of course, we don’t say all that at once; we remember and wonder together; we pause and listen and have a conversation. When we can keep ourselves in the mode of playful, curious exploration, accepting whatever gets uncovered, very often clients will decide, yes, they would like to try something new.
But they also quickly feel lost about how to proceed and may ask for input. Then we have a chance to talk about how to make space for two people to hear each other’s feelings. We suggest that our client might begin by telling Jane she understands her excitement about the wedding, and her need to talk about it. We explain, “That makes it easier for Jane to hear what’s bothering you. Especially if you can say it’s just about something she does sometimes, not about who she is to you, and how when she does that one thing, you end up feeling like you don’t matter.” We ask our client how she’d feel if a friend talked with her like that. Would she get defensive and angry? Might she be able to listen?
Far more often than not, if clients follow through on a careful plan to share emotion with someone they feel they can probably trust, they come away pleasantly surprised by their new experience, if not downright shocked and exhilarated. This is not what they know in their bones: in a shamed client’s inner world, affective attunement did not happen, and so, where empathic connection could be, there’s shut-down self-protection. There’s not even a felt sense of empathic possibility.
As Jordan explains, relational therapy brings a person back into connection in which empathic possibility exists. We can help our clients explore empathic possibility outside of therapy, too. Within any connected relationship, as empathy for self and other increases, shame decreases.4 Then a more robust mutual empathy makes possible deeper, richer connection. This connected sense of authenticity is what our clients need to experience—over and over again, in as many contexts as possible, until it’s no longer a surprise. This is not assertiveness training. Authentic connection is sharing emotion within “I-see-you-seeing-me” intersubjective space: I will tell you what I feel because we each hear and care about how the other feels.
The language of “getting my needs met” bothers me. Even though I often say that the suffering of chronic shame has its roots in a person’s early unmet needs for emotional connection, I don’t make it a project with clients that they try to get their emotional needs met from the people in their lives. The project feels to me like the opposite of authentic connection. It seems to reduce moments of interpersonal mutuality—of desire and risk, hope and disappointment, giving and receiving—to a list of needs managed by a series of transactions. What a left-brain way to try to get emotional connection!
But the language of “getting needs met” does seem to appeal to many shame-prone clients, perhaps because a project organized by the left brain creates a sense of safety for them. For shamed people, needing is indeed dangerous territory. If they had never needed attuned, engaged responsiveness (and then failed to get it), they never would have fallen so far into shame. Needing is the original “something wrong with me.”
It’s small wonder that persons once deeply shamed by emotional need might jump at the chance to make their needs “all good.” I suspect, though, that this nifty reversal simply bypasses relational shame. Insisting on “getting my needs met” puts my needs in the third person and distances them from myself. I’m not looking you in the eye and saying, “I would like this from you,” nor am I inviting you to tell me how that is for you, or what you might like from me, too. Ironically, talking about my needs lets me escape the relational moment of being a needing self with you. I don’t risk being thrown into relational shame all over again—but I also fail to make genuine contact with you.
If clients of mine want to discuss getting their emotional needs met, I don’t, however, quibble with their language. I do ask them to tell me more about those needs in their relational contexts: What’s happening with somebody when a need comes up? What do they feel and want in that moment? I try to help them imagine details of conversations they could have. How will they tell their partner (for example) exactly what they would like? Do they think they will be heard? What can they do to increase the likelihood of mutual listening? How will they feel if their partner wants something in response, or in kind?
What my clients need from others matters, of course. But I’m attuned to another kind of need, one they gave up feeling a long time ago. They need to be able to have safe, real conversations about what they want and don’t want from people close to them. If their shame is truly to diminish, what their needing, desiring, vulnerable self needs most of all is to make authentic reciprocal connection with others. In the process, some of their needs will get met, but what matters most is the negotiation. As in the dance of continual miss/repair attunement between mother and infant, the negotiation is the authentic connection, the place where the self finds safe freedom to work through desire and emotion with another.
At the beginning of therapy with chronically shamed clients, we may notice how susceptible they are to feeling unreasonably responsible for anything that goes wrong in any of their relationships. These are moments to be curious, and also, perhaps, to say, “I don’t think that just because someone feels bad, that means you’re at fault.” This may be a new and intriguing idea for them. There may be a chance, then, to talk about how blame and shame affect relationships, perhaps with a link to the family system in which they grew up.
Nobody—and especially not somebody prone to shame—wants to see himself or herself as a person who inflicts blame or shame on others. That’s why places where clients are the target of blame are the best places to help them learn how blaming works: “She believes that the only way for her to feel better is to ‘make you bad.’ I guess she can’t be vulnerable enough to talk about her own feelings. It takes some real courage to do that, to own what you feel.”
When clients come to understand the shame/blame dynamic, they want out of it. They want family members and friends to be more vulnerable and emotionally responsible with them. Then they find that if they want changes in their relationships, they’ll likely have to take the lead. Instead of responding to blame with blame, they’ll have to respond with their own feelings and experience. That’s when they look to us for guidance in how to be more vulnerable and responsible.
The groundwork will have been laid. By now clients will have spent many hours with us, developing new neural networks about being understood and accepted. They know we won’t “make them bad” for their feelings or thoughts. They don’t need splits and defenses as much as they did before. In this more relaxed, connected state of self, clients know what empathic possibility feels like. And so they can explore how to keep empathic possibility open in their difficult conversations—empathy for themselves and for others—even imagining that others might have empathy for them, given a chance.
Our clients will look to us to model vulnerability, authenticity, and empathy—the alternatives to blame. Therefore, when our feelings are present in the therapy room, we acknowledge them. When we make mistakes, we say we’re sorry, and if a mistake, such as a double booking, has consequences for a client, we make amends. If there’s a misunderstanding between us, we don’t blame our clients, but try to see both sides of what happened.
If our clients are angry with us in a blaming way, we feel the blame, of course, but we don’t retaliate with defense or with counter-accusations. Instead, we try to understand what they feel about what we did. We show them it’s possible to take responsibility for our own actions, to understand and care about how the other person feels in response, and at the same time not to take the blame for how the other feels. This kind of emotional/relational learning is a right brain experience. Even without being explained, it can generate major change in our clients’ capacity to exit shame/blame cycles and to relate to others more openly and authentically.
If we are a lucky kind of unlucky, we will have chances to share with our clients the relational sequence of injury, guilt, remorse, and forgiveness within the client–therapist relationship. Important new experience can happen whether we or our clients cause the injury. For the sake of example, let’s say that we have injured a client. And let’s put this uncomfortable story in the first person; I’ll wear the guilt for the sake of the learning.
Let’s say that after a night of broken sleep, I’m not at my best. Having mustered the adrenalin to bring some calm and focus to a couple in crisis, I take ten minutes for quick notes, and then I welcome my client into her weekly session. She looks tense, and she tells me she’s had a terrible week, therapy isn’t working, it never has worked, and it probably never will. I know this is a state that overwhelms her regularly. I know I need to bring curious empathy to the emotional reality behind her statements. I also know she’ll say that she isn’t angry, she’s just hopeless, and can’t I see that she has every reason to feel hopeless.
I do my best to squash my rising frustration, trying to enact “good therapist.” But of course she knows (her right brain knows) that I’m not really there in my stabs at curious empathy, that really I’m fed up and angry myself. Eventually, as nothing shifts between us, I happen on an idea. I don’t think it through, and it feels like a relief. I say in a calm, good-therapist voice, “You know, you may be right. Maybe this therapy isn’t working for you. We’ve struggled with it for quite a while. Maybe what you need is something more intensive, maybe psychoanalysis two or three times a week. Maybe that would keep you from falling into these states between sessions that feel so awful. And then your life would be more bearable.”
It’s as if she hasn’t heard me. We go on to other details of her life that aren’t working out, and then the session ends uneventfully. But by the time she returns a week later, she knows that she is feeling terribly hurt and misunderstood. She also feels like she’s too much for me and I’m trying to get rid of her.
Then I have to face that I have done something that has caused my client injury. It’s true: in the previous session, my stressed state of self could not manage her disruptively anxious affect, and yes, I wanted to be rid of her, at least in those moments. Now I have to access quickly everything I know about the uselessness of falling into shame about my failure, and about the value of owning up to making a mistake that has caused injury.
I tell her that I understand what she’s saying and that I remember what I did. I ask her to tell me more about what that was like for her. As I listen, I also have time to assess my guilt and consider the best way to speak of it. I decide not to speak of my stressed state last week (defensive), or about how her hopelessness wears me down (blaming). Instead I decide to tell her simply that she’s right about what I was feeling and what I did.
I say: “In that session, I wasn’t feeling very capable, and what I said was to make me feel better, not to help you. I tried to make it look like help. But I know that what I said was hurtful, and I’m sorry that I hurt you. I’m sure it felt like I was getting back at you for being angry. I think I had some angry feelings, but I didn’t let myself know about them. I knew that I didn’t want to keep on doing what I was doing, feeling what I was feeling. So in some way I was trying to get rid of you—and that’s why it felt that way.”
I check that so far I’m hearing her feelings accurately and making sense. She says that I am, and so I go on: “I know that our deal here is that you bring whatever you’re feeling, and it’s my responsibility to help you explore and make sense of it—not to react to it. So I failed on my side. I made a serious mistake. I appreciate that you’re holding up your end by telling me how you feel about what I did. I do owe you an apology, so let me say again that I’m sorry, and that I’ll do my best not to fail you in that way again.”
My client is looking at me, undistracted. Her eyes are clear; her face is no longer tight with anger. She says, “Thank you for saying that.” I nod, accepting her thanks. She adds, “I needed to hear that.” I nod again, feeling mostly forgiven and sensing more connection between us than I have sensed for a long while. I feel grateful for what I’ve learned about aspiring to guilt instead of falling into shame. If I can be a good therapist who did a bad thing, I don’t have to cut myself off from my client in abject shame; I can move toward her with remorse appropriate to the size and meaning of the bad thing done. Then we might have an affectively potent opportunity—just like this—to find out that the sequence of injury, guilt, remorse, and forgiveness can create connection that feels authentic and meaningful.
When I think about this event in the weeks following, I realize that this client, with her intense, painful shame, has always tried desperately never to be in the wrong with anyone. But now she has begun to talk about times in her life when she wishes she had been “nicer.” She wonders if she’s making some mistakes with her anger, and we wonder together whether mistakes are tolerable and fixable. I talk about the goodness of guilt as opposed to shame—about how sometimes saying you’re sorry from a place of remorse, not shame, can bring you closer to the other person. We even talk a bit about the awful angst of shame.
All of this is about her life “out there.” Since my client doesn’t mention what happened between us, I don’t bring it up. She may not see the connection consciously; perhaps a shift is happening in her right-brain neural networks that register implicit relational knowing. I hope she can begin to give up the isolation of shame for the authentic connectedness of guilt, remorse, and forgiveness. I’m happy that, whether or not she remembers, I have “walked the walk” with her.
According to relational theories of psychoanalysis and psychotherapy, our sense of self comes into being through connection with others.5 Not only is a core sense of self created by our early relationships, our current sense of self is an ongoing, fluctuating product of relatedness.6 Our self-experience may in any moment be altered by the here-and-now quality of a particular connection with another person.
In analogous ways, our felt sense of self is also the product of the relationship of self-with-self. This internal relatedness-in-motion is created by a part of our brain that constantly synchronizes internal cognitions, emotions, body feelings, memories, and fantasies into patterns recognized as the self’s own. Even if the multiplicity of our selves or self-states barely registers with us, what holds us in coherence is the moment-to-moment connection we experience among our various parts of self.
Therefore it’s important that we talk with our clients, not about uncovering their one true, authentic self, but rather about finding connection with and among their diverse experiences of self. This goal meshes well with a simple explanation of how relational psychotherapy works, one that makes good sense to most clients: In relational therapy you take the time to have a genuine, meaningful relationship with another person so that you can have a genuine, meaningful relationship with yourself.
Clients who suffer from chronic shame find relating to others and to self equally difficult. Just as we can help them learn to be in more authentic connection with us and with the other people in their lives, so too we can help them begin lifelong habits (develop new neural networks) of connecting more authentically with themselves. Three habits of connecting with self are particularly useful in countering the effects of chronic shame: self-compassion, mindfulness, and self-expression.
Shame theorists note that shamed clients have an especially destructive, non-empathic self-to-self relationship. Paul Gilbert summarizes studies that find self-criticism to be the major link between relational trauma and depression and anxiety. He concludes, “It is the way in which difficult, stressful, and traumatic experiences influence self-to-self relating that is key to vulnerability to psychopathology.”7 Changing this damaging self-to-self relationship is far from easy, however, since high-shame people have little experience of compassion from others or from self. Gilbert concludes that we can’t just hope that our clients will grow into self-empathy; we need to teach our high-shame clients self-compassion, and to that end he suggests Compassion Focused Therapy.
Gilbert begins, as all relational therapists do, by demonstrating non-judgmental, caring curiosity in interactions with shamed clients, showing them how they can think about troubling feelings, be “mindful” about them, and simply accept them. He mixes this right-brain modeling with left-brain teaching, taking psycho-educational opportunities to normalize or “de-shame” negative emotions, internal conflict, and ambivalent feelings. He validates shame experience as painful and understandable, given the client’s history and life circumstances.
Gilbert shares with clients his understanding that they may have learned to blame themselves in order to keep themselves safe in dangerous relationships, and he helps them consider what they might risk in relationship if they stopped being so self-critical. He helps clients learn the difference between shame-based self-criticizing (with its emotions of anger, contempt, and disappointment) and compassionate self-correction, in which clients can recognize errors as guides to growth and improvement. Not surprisingly, Gilbert also suggests guidelines to help clients distinguish between feelings of shame and feelings of guilt.8
Since all of these left-brain interventions offer clients an attuned, validating experience, they also speak subliminally to a client’s right-brain shame. But how might we speak more directly to it? Gilbert explains that our most compassionate efforts may not touch a client’s shame when the client has never experienced positive emotional regulation. Clients who grew up deprived of empathy or compassion can’t access an endorphin/oxytocin emotional regulation system, which, in contrast to the dopamine excitement system, generates soothing, calming feelings and creates a sense of closeness and connectedness. Thus Gilbert arrives at this critical question: “Can we teach people how to practice and generate a particular type of self-to-self relationship that is based on self-compassion . . . with the aim of stimulating the soothing system?”9
Gilbert’s answer is, “Yes,” and the kind of “teaching” his answer describes is highly right-brain/experiential. He suggests that we help clients feel into the attributes of compassion, first of all helping them experience self-compassion as desirable instead of weak. We invite them to be as sympathetic to their own feelings and needs as they would be to the feelings of others. We stay close to their experiences of pain and fear, letting them see that we are touched by their trouble, and inviting them to be moved by their own distress. We support them to tolerate unpleasant negative emotions and frightening positive emotions. In a mentalizing way, we gently understand the “safety strategies” they learned early in life. Again and again we bring compassionate nonjudgment to the therapy conversation we share with them.10
Gilbert also tells us to teach the skills of compassion. We do so by helping clients pay attention to problems in ways that are useful and forward-looking instead of self-critical and self-limiting. Helping them develop these skills takes much kind, supportive repetition, and we have to remember that what matters most is that our clients learn to hear and feel the emotional tone of each self-to-self conversation they have. Gilbert admits that helping shamed clients feel warmth, kindness, and encouragement for themselves can be very difficult. And yet developing a positive self-to-self emotional tone is so important to the success of their therapy that it should be an explicit focus of our work with them.
To boost this right-brain learning that can be so difficult, Gilbert suggests exercises that heighten the experience of self-compassion. An exercise might begin with a focus on self-quieting breathing. Then a client is invited to imagine being a compassionate person. She is asked, while being this compassionate person, to pay attention to the expression on her face, the tone of her voice if she were to speak, and the feeling-quality of her thoughts. While securely in the role of compassionate self, she is invited to watch as if on video replay the anxious, fearful self she has stepped away from for a moment. The point of the exercise is simply that she feels compassion for that self. If self-criticism begins to break through, the video fades to black, and the client re-focuses on inhabiting the role of compassionate self.
The details of such an exercise matter far less than the overall idea: “to create experiences in which clients can engage with problematic aspects of themselves, but through the eyes of the compassionate self.”11 This compassionate self can become a center from which chronically shamed clients can explore memories and feelings that would otherwise be highly likely to stimulate self-blame and self-criticism. Gilbert notes that the compassionate self can be understood as one of a number of other possible selves (for example, an angry self, an anxious self, a lonely self), and that with practice the compassionate self can find a significant place in a client’s diverse self-system.
In my practice, I have never (yet) used such an explicit exercise to bring to life a client’s compassionate self. I’m more likely to nudge a client toward compassion from within our conversation, in much the same way as I speak of parts of a client’s self that have just “turned up.” I certainly recognize and affirm a client’s compassionate self whenever he or she appears, however fleetingly. Gilbert’s clarity about how shamed clients deeply need—and don’t have—self-compassion helps me understand better what makes authentic connection with self so difficult for them. I become more alert for moments when I can help clients ease into a compassionate mind toward themselves. Sometimes being more helpful means just holding my clients’ need for a compassionate self in mind, hoping that some mentalization of self-compassion will happen subliminally.
The habit of mindfulness, understood in its simple, secular sense as reflective awareness of the present moment, is good for anyone’s mental well-being. So says attachment-trained and neurobiologically-informed psychiatrist/psychotherapist Daniel Siegel, as do many proponents of mindfulness practice.12 Many shame theorists suggest that the habit of mindfulness can be especially useful for clients who want to experience changes in their shame-constricted neural networking.13 Practicing mindfulness is a good way for them to give themselves a better chance at lifetime shame reduction.
As Siegel describes mindfulness, it’s more than neutral reflective awareness of the present moment; it’s a way of approaching each moment of our here-and-now experience with curiosity, openness, acceptance, and love.14 Mindfulness is the intentional, focused practice of putting aside preconceptions and judgments in order to be present to our own experience with kindness and respect. Put very simply, it is self-compassion, and as a daily repetitive practice it lays down neural networking, including access to an endorphin/oxytocin emotional regulation system, that supports the experience of connected well-being.
If we practice therapy from a developmental/relational perspective, we believe that our clients internalize the capacities for emotional regulation, mentalization, and compassion that are embedded in how we relate to them. We don’t re-parent them, and yet our clients take in these right-brain “goods” in much the same way that children internalize their parents’ emotional capacities and intentions. The practice of mindfulness allows our clients to give themselves more of the same goods they receive from us, and on a daily basis. The guiding hypothesis of Siegel’s book on mindfulness is that the practice of mindfulness promotes well-being because it is an attunement to self that works (fires neurons) very much as interpersonal empathic attunement works, and with many of the same effects.15
Siegel proposes that the attachment experiences of childhood can be replicated to a significant degree in adulthood by the practice of attunement to self. Mindfulness can be one of many relational experiences that promote the development of self-regulation in the brain. If we think of mindfulness as a secure relationship with ourselves, we can understand how this internal attunement would support capacities such as affective body-regulation, emotional balance and flexibility, attuned communication, empathy, self-awareness, and fear modulation.16 (We also note that these capacities would be on Schore’s “right-brain” list.) Siegel acknowledges that brain research does not yet validate this correspondence between interpersonal attunement and personal mindfulness, but he cites some studies that move in that direction.
Siegel also hypothesizes that self-attunement involves the creation of highly complex functioning in the brain that has the quality of neural synchrony, that is, “the harmonious firing of extended neural groups when they become linked in a state of neural integration.”17 Neural synchrony is felt subjectively as a state of coherence. Hard evidence for this synchrony is also elusive. But Siegel believes that first person accounts of the well-being and harmony that emerge with mindful awareness practices give substantial evidence (if not from brain research) to support his belief that self-attunement creates coherence in the mind.
In a full circle most interesting to a relational psychotherapist, Siegel brings his argument for self-attunement back around to interpersonal connectedness. He names three basic, interdependent aspects of mental well-being—neural integration, mental coherence, and empathic relationships. Each is necessary and they are irreducible to one another. Self-attunement leads to neural integration and mental coherence, which enhance interpersonal empathy. The interpersonal attunement of secure relationships interacts with personal mindfulness to produce even more neural integration, which is felt subjectively as coherence, harmony, and well-being.18
If mindfulness and empathy go hand in hand, neither we nor our clients need fear that a commitment to mindfulness will reinforce their anxious, narcissistic preoccupations. On the contrary, their commitment to openness and acceptance will naturally embrace others as well as self. We can also expect that as our clients gain a secure, empathic relationship with self that is something like a child’s mutually empathic relationship with a parent, they will use their security as a base from which to explore the world with curiosity, passion, and self-expression.
The benefits of mindfulness are not reserved just for those dedicated persons who are able to sustain a daily practice of meditation. Some of our chronically shamed clients will find it very helpful to learn a formal mindfulness practice, and it’s worth mentioning the possibility of such learning to all of them. However, we can also remember that in a very significant way, the process of open-ended, curious, empathic, and accepting psychotherapy is itself a process of mindfulness. As Siegel emphasizes, interpersonal and intrapersonal attunement are very closely related. Within the ambience of our compassionate, nonjudgmental interest, clients are “induced” into taking that same kind of interest in themselves. We can expect that after absorbing many hours of kind, respectful interest during therapy, our clients may be able to learn to give some of that attentive kindness and respect to themselves.
It’s evident that self-compassion and mindfulness are modes of authentic connection with self, and it’s also easy to see how, as kind habits of mind, they counteract the effects of chronic shame. But how is self-expression an authentic connection with self, and how is it an antidote to shame? I can answer these questions only by first saying that I have in mind a very particular kind of “self-expression,” one most clearly defined as not the performance of self that a client’s shame-defenses have always demanded.
Chronically shamed clients enter therapy with unconscious commitments to performances of self that protect their vulnerability. As we have seen, these performances range from helpless rage to aloof self-sufficiency, to complex “split” character solutions to the problem of shame. To call them performances is not to demean the performers. In every case, our clients are doing what they have learned to do to make necessary contact with the world while avoiding the contact that they know will leave them alone, once again, with a needing, empty, humiliated self. But all the energy they spend on managing a dangerous relational world is energy not available for them to explore what actually moves and excites them in life.
Psychotherapy creates interpersonal space in which, over time, shamed lonely selves can come to be known and understood, and in that process, self-protective performances of self become less necessary. In brand-new ways, our clients can afford to know who they are and what they feel, and their process of coming-to-know is intimately and reciprocally connected with their process of coming-to-say.
This emergence of self-expression begins slowly, with the expression of feelings that have been denied. Clients allow that they feel anger and envy. They remember anguish from the past, and they acknowledge pain in the present. They make emotional contact with hidden longings, and they grieve their losses with deep sadness. They feel both the kindness and the trouble in their relationships, and they make choices to interact more authentically with those close to them. They take comfort in being understood, and they use support to make necessary changes in their lives. All of this is the expression of an emotional/relational self in the world, a self gaining enough strength and self-awareness to face shame, too.
Brené Brown and others suggest that in order to develop shame resilience, shame-prone people need to reach out and speak their shame.19 I agree that shame loses power when people are able to put it out where light and air and the acceptance of others can get at it. I also agree that the process of speaking shame makes way for more authentic expressions of self. For Brown, authenticity has to do with accepting imperfection, limitations, and vulnerability. Authenticity exercises compassion in the face of struggle, and it nurtures resilience and connection. Authenticity, for Brown, is about being enough, and it’s not an achievement; it’s a practice, a series of conscious daily choices about how to live.20 In other words, authenticity, self-compassion, and mindfulness belong together.
Therapy is a training ground not only for self-compassion and mindfulness, but also for authentic self-expression. In the interactions of therapy, the neural networks of I feel, I want, I choose, I intend, I enjoy, and I will do are laid down well enough to begin to override networks based on shame and fear, and also to begin to override the compensatory networks of performance and perfection. For our chronically shamed clients, the emergence of this ordinary, daily, grounded self-expression is both compelling and fragile. It deserves and needs our direct encouragement.
We help our clients develop shame-reducing neural pathways of self-expression when we respond to their emergent self-discovery with genuine pleasure. As the power of their past diminishes and the future beckons, we let them know that talking about exciting “good stuff” is just as important as talking about painful stuff. We understand how scary it is for them to try to do something that might not turn out well, and we help them focus on the doing of it, whether it’s joining a running group, building a garden, or writing a poem. What does it feel like to do this? How is it a part of who you are? What does it mean to you to do this? As our clients’ new initiatives emerge, we speak these questions gently, with playful, empathic curiosity.
It’s our privilege to help our clients master their fears of making mistakes, supporting them to “goof bravely.” We help them accept the bruises their self-esteem suffers as they take more chances in the world. After a while, we notice with them that their dreams are no longer escape fantasies, no longer compensatory illusions to make up for hidden self-loathing. What they want is possible, and we back them up as they go after it.
Somewhere in this process of learning how to be an imperfect, vulnerable self capable of compassion and creativity, our clients come to realize that they are the persons they always were—and yet there is something new. What’s emerging isn’t a brand-new authentic self, but on the other hand, it’s more than just a reduction in the intensity and frequency of their feelings of shame. Underneath this movement toward lifetime shame reduction, there is something transformative after all. Their relationships with others and with themselves are changing profoundly, and at the center of this transformation is a new relationship with their own shame.
Our clients are no longer at the mercy of a disintegrative power they don’t understand. They can tell a story about what happened to make them feel so bad. They feel better when they reach out to us and others for comfort or reassurance. They can calm and soothe themselves. Shame no longer owns them; they own it. They know where their shame hides out, when it attacks, and how to limit the damage it does.
As our clients accept the challenges of lifetime shame reduction, they become ever more aware that there are no perfect families, no perfect lives, and no perfect endings. That’s often when they start to think about ending therapy. Imperfection, finitude, mortality—it’s all part of life, they tell us now. But it’s sad to see them go. With their acceptance of the limits of therapy and the limits of life, they have found humor and wisdom, too. Our connection feels warm and infused with mutual understanding. But that’s not a good enough reason to keep doing therapy. And so we say good-bye . . . at least for now. They may be back, they say. If they need to see us, they’ll call. They know and we know that there would be no shame in that. Because being vulnerable and needing others is the human condition, and we’re in it together.
1. Some brain-aware therapists believe that implicit relational learning can be erased. In Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation (New York: Routledge, 2012), Bruce Ecker, Robin Ticic, and Laurel Hulley teach therapists to induce emotional experiences that reactivate specific old learnings and then to hold them open in the presence of new emotional learnings that do not match the old. With good planning and timing, such an “erasure sequence” can eliminate symptoms rapidly, effortlessly, and permanently, they maintain.
2. See, for example, Norman Doidge, The Brain that Changes Itself (New York: Viking, 2007).
3. Judith Jordan, “Relational Development: Therapeutic Implications of Empathy and Shame,” in Women’s Growth in Diversity: More Writings from the Stone Center, ed. Judith Jordan (New York: Guilford, 1997), 138–61.
4. Jordan, “Relational Development,” 152–53.
5. For example, self psychologists maintain that a cohesive sense of self emerges from self-object experiences that are grounded in affect attunement. Mentalization theory tells us that a child comes to know his own mind (or self) as his mind is held within the mind of another. In affect regulation theory, a sense of self emerges as a right brain experience when a child’s affect finds the consistent regulation from another that’s necessary for optimal right brain development. Stone Center self-in-relation theorists believe that empathy for oneself becomes possible only as one experiences another person’s empathic understanding.
6. My thinking here aligns more with theorists of the Interpersonal/Relational school of psychoanalysis who, along with Stone Center self-in-relation theorists, de-emphasize the existence of an ontologically defined singular self; self psychology and other developmentally oriented theories still seem to count somewhat on the notion of an individual, historically constructed, essential self.
7. Paul Gilbert, “Shame in Psychotherapy and the Role of Compassion Focused Therapy,” in Shame in the Therapy Hour, eds. Ronda L. Dearing and June Price Tangney, (Washington, DC: American Psychological Association, 2011), 330.
8. Gilbert, “Compassion Focused Therapy,” 331–38.
9. Gilbert, “Compassion Focused Therapy,” 341.
10. Gilbert, “Compassion Focused Therapy,” 341–43.
11. Gilbert, “Compassion Focused Therapy,” 345.
12. Daniel Siegel, The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (New York: Norton, 2007); see also Jon Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (New York: Dell, 1990) and Coming to Our Senses: Healing Ourselves and the World Through Mindfulness (New York: Hyperion, 2003).
13. For example, Gilbert, “Compassion Focused Therapy,” 343; Leslie Greenberg and Shigeru Iwakabe, “Emotion-Focused Therapy and Shame,” in Shame in the Therapy Hour, eds. Dearing and Tangney, 77; Brené Brown, Virginia Hernandez, and Yolanda Villarreal, “Connections: A 12-Session Psychoeducational Shame Resilience Curriculum,” in Shame in the Therapy Hour, eds. Dearing and Tangney, 364; Shireen Rizvi et al., “The Role of Shame in the Development and Treatment of Borderline Personality Disorder,” in Shame in the Therapy Hour, eds. Dearing and Tangney, 249.
14. Siegel, Mindful Brain, 15.
15. Siegel, Mindful Brain, 17.
16. Siegel, Mindful Brain, 191.
17. Siegel, Mindful Brain, 193.
18. Siegel, Mindful Brain, 198–201.
19. Brown, Hernandez, and Villarreal, “Connections,” 368.
20. Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are (Minneapolis, MN: Hazelden, 2010), 49–50.