09 Sep A Foremost Goal of Psychotherapy: Healing Shame

Posted at 10:49 am in Individual Therapy by jlbworks

A Foremost Goal of Psychotherapy: Healing Shame—That Deep- Seated and Painful Belief That Something is Wrong with Me, that I’m Irreparably Flawed, that I’ll Never Be Okay, and that Others Can See That I’m Inferior

By Philip Chanin, Ed.D., ABPP, CGP
Board Certified Clinical Psychologist
Assistant Clinical Professor, Department of Psychiatry
Vanderbilt University Medical Center

As a friend of mine put it, ‘Feeling that something is wrong with me is the invisible and toxic gas I am always breathing.’ When we experience our lives through this lens of personal insufficiency, we are imprisoned in what I call the trance of unworthiness. Trapped in this trance, we are unable to perceive the truth of who we really are.

A meditation student at a retreat I was teaching told me about an experience that brought home to her the tragedy of living in trance. Marilyn had spent many hours sitting at the bedside of her dying mother—reading to her, meditating next to her late at night, holding her hand and telling her over and over that she loved her.

Most of the time Marilyn’s mother remained unconscious, her breath labored and erratic. One morning before dawn, she suddenly opened her eyes and looked clearly and intently at her daughter. ‘You know,’ she whispered softly, ‘all my life I thought something was wrong with me.’ Shaking her head slightly, as if to say, ‘What a waste,’ she closed her eyes and drifted back into a coma. Several hours later she passed away.

We don’t have to wait until we are on our deathbed to realize what a waste of our precious lives it is to carry the belief that something is wrong with us. Yet because our habits of feeling insufficient are so strong, awakening from the trance involves not only inner resolve, but also an active training of the heart and mind.” (Radical Acceptance: Embracing Your Life with the Heart of a Buddha by Tara Brach, Ph.D., p. 3)

“A woman will feel guilt and shame, but shame will be the emotion she finds most difficult. Guilt is usually associated with a deed that can be forgiven, but shame encompasses her being, taking on an ‘all or nothing’ quality, which has devastating consequences for mental health. Adult daughters of narcissistic mothers often refer to themselves as ‘damaged’ or ‘damaged goods,’ particularly after a series of failed love relationships. Underneath this shame is the feeling that they are unlovable.” (Will I Ever Be Good Enough?: Healing the Daughters of Narcissistic Mothers, by Karyl McBride, Ph.D., p. 110)

“W.R.D. Fairbairn, a Scottish psychoanalyst (worked with) children who were forcibly removed from their abusive homes…He noticed, much to his surprise, that these children could not under any circumstances admit to themselves that their parents were brutal, unfair, and bad parents. Conversely, these very children were deeply ashamed of themselves, because they (mistakenly) saw themselves as bad children and as the source of all their families’ problems.

Fairbairn concluded that this source of shame resulted from the children’s attempt to deny their parents’ badness by taking the badness into themselves, thus keeping the parents good…he noted that these children cited ‘moral’ failures of their own (lying, being dirty, not doing well in school) as the reason for their parents’ continued abuse of them.

Fairbairn realized that neglected and abused children perform this psychological reversal because of their absolute dependency on their parents as well as their need for security is a very insecure world. It is simply intolerable for children to admit to themselves that they have unpredictable and abusive parents, because that admission condemns them to a life of anxiety and a lack of control…This type of future is simply too frightening for any child to contemplate.”

(The Illusion of Love: Why the Battered Woman Returns to Her Abuser, by David Celani, Ph.D., pp. 7 & 106)

I begin this article with these three quotations, each of which illustrates in a slightly different way the devasting impact of shame. The Fairbairn quote helps us to understand how shame often can be traced to childhood experiences of neglect or abuse.

Many patients come to psychotherapy with a very deep and life-long idea that they are bad. The best term for this idea is shame. In my experience, as a person and as a psychotherapist, shame is the emotion that takes the longest to heal. This is because shame is more than an emotion—it is a deep-seated belief that one is not good enough and irreparably damaged in some way.

In his famous book, The Road Less Travelled (1978), M. Scott Peck writes about the absolute necessity of parental love and attention for any child to develop a sense of self-worth. “Children who are truly loved…unconsciously know themselves to be valued. This knowledge is worth more than any gold. For when children know that they are valued, when they truly feel valued in the deepest parts of themselves, then they feel valuable.”

Peck goes on to say, “This feeling of being valuable is a cornerstone of self-discipline because when one considers oneself valuable, one will take care of oneself in all ways that are necessary. Self-discipline is self-caring…If we feel ourselves valuable, then we will feel our time to be valuable, and if we feel our time to be valuable, then we will want to use it well.”

Peck gives an example of a patient who did not have this experience in her childhood: “(Her parents) did not value her. They did not want to care for her. So, she grew up feeling herself to be of little value, not worth caring for; therefore, she did not care for herself; She did not feel she was worth disciplining herself…she required the most elementary instruction in self-discipline, because she lacked a realistic assessment of her own worth and the value of her own time.” (pp. 24-25)

Terrence Real, in his powerful book I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression (1997), writes about how many individuals, and particularly men, try to cope with their painful feelings of shame by converting them to grandiosity—going from “less than” to “better than.” Real also suggests than in an effort to deal with a lack of self-esteem, many individuals resort to relying on “performance-based self-esteem.”

Related to performance-based self-esteem is perfectionism, which is characteristic of many patients with deep shame wounds. Several months ago, a 30-year-old male patient with deep shame wounds from his narcissistic father, stated in a therapy session, “I have this desire for a perfect body, for me and for my wife. I want to be a super employee. My notes have to be perfect. I compare myself to others—when I see somebody doing something better than me.”

Last year I was seeing a 41-year-old male patient with lifelong self-esteem problems, to whom I introduced Terrence Real’s book and these concepts. In his 8th session, this patient said to me, “Performance-based self-esteem—that’s the way I figured out how to feel I’m achieving whatever the standard is—hard to come off that competitive, performance-based aspect. But I don’t want my self-esteem to be based on my last performance, or if it’s better than the others. It’s a challenge to break that way of thinking.”

The patient continued, “My life has been built around performance-based self-esteem…I have to work to eventually get out of that mindset. It always has stood in my way. My own judgment.” At this point in the session I asked him, “Being good enough isn’t an acceptable category?” He answered, “I have to be the best. Not ‘good enough.’ But I’m so far from the best. Perfectionism—the shame wrapped up in it. I’m so wrapped up in my insecurity.”

Then he added, “It has cost me. The grandiose thing I do is say, ‘I don’t care about this!’” “So you do the opposite?,” I asked. He responded, “I’m shameful about how much I can do. But I act like I really don’t care, to throw everybody off the track. This attachment I’ve struggled with for a long time. Status anxiety—really suffering with that. I’ve never been able to step back from the grandiosity long enough to be a person who works on this.” “Without grandiosity or shame?,” I asked. He immediately responded, “It’s all grandiosity or shame.”

For many who struggle with shame, the most devastating experience is what I call a “shame attack,” when an interaction leads to an overwhelming sense of worthlessness, and the sense that others in the interaction can see that I’m irreparably damaged. In his book The Power of Now: A Guide to Spiritual Enlightenment, Eckhart Tolle uses the term “pain body” to describe shame. Tolle vividly describes a shame attack:

“Watch out for any sign of unhappiness in yourself, in whatever form—it may be the awakening pain-body…Catch it the moment it awakens from its dormant state…So the pain-body, when it has taken you over, will create a situation in your life that reflects back its own energy frequency for it to feed on. Pain can only feed on pain—you want to inflict pain, or you want to suffer pain, or both.”

(However) the pain-body is actually afraid of the light of your consciousness. It is afraid of being found out—So the pain-body doesn’t want you to observe it directly and see it for what it is. The moment you observe it, feel its energy within you, and take your attention onto it, the identification is broken—You are now the witness or the watcher of the pain-body. This means it cannot use you anymore by pretending to be you, and it can no longer replenish itself through you.” (pp. 29-31)

I talk with my patients about utilizing Tolle’s imagery in recovering from shame attacks. We discuss this idea of becoming “the witness or the watcher of the pain-body.” I say to my patients, “Those negative words in your head are old tape recordings that you play. They are not you. You can become the witness, separating yourself from those inner critic monologues.”

Individual Psychotherapy

My approach to healing shame with my patients involves three key components: individual psychotherapy, group therapy, and Buddhist meditation and psychology. How does individual psychotherapy heal shame? How is the deep belief that one is irreparably damaged replaced with a coherent sense of self and of being okay as one is? David Celani, who is quoted at the beginning of this article, describes this process: “In truth,” he writes, “it happens slowly over time, like grains of sand falling in an hourglass.”

“Each small positive introject (of the therapist) weighs little individually…Because of the gradual nature of the introjection process, very little appears to happen at the onset of therapy, as there are too few positive introjects to alter the patient’s normal coping strategies.” (pp. 182-183). Dr. Celani adds, “The struggle between the newly internalized memories and the enormous pressures from inner emptiness turns out to be a David and Goliath battle, as it seems impossible for the fifty-minute hour to compensate for a lifetime of neglect.” (p. 191)

In individual psychotherapy, the therapist both listens empathically to his/her patient, and challenges, as Elan Golomb writes in Trapped in The Mirror, “the hideous self-image that was put in place by endless demands for change.” Patients with deep shame wounds usually struggle with a virulent “inner critic voice.” When I asked a male patient, aged 30, about his inner critic voice, he responded, “Sometimes it narrates my whole day, especially at work–if I do one little thing wrong, I think, “I’m a terrible employee!”

Like other patients with deep shame wounds, this patient is obsessed with the issue of whether others like him. In a therapy session, he states, “I’m desperate to be liked. I ask myself, ‘How can I get people to like me?’ I worry about what other people think of me. I ruminate, ‘Was this person upset with me? They must not like me!’” Another male patient, aged 31, struggles with shame wounds in his marriage. He states, “I shame myself. I ask my wife, ‘Am I enough for you? Do you really love me?’”

Nancy McWilliams, in her classic book Psychoanalytic Case Formulation (1999), suggests how shame wounds are healed in the course of an extensive psychotherapy experience. She writes:

“Although contemporary analysts consider understanding, especially the affectively charged ‘Aha!’ kind of understanding that has been termed ‘emotional insight,’ to be of immense therapeutic significance, they also credit numerous ‘nonspecific’ factors (e.g., the therapist’s quiet modeling of realistic and self-respectful attitudes, the client’s experience and internalization of the therapist’s stance of acceptance, the fact that the therapist survives the patient’s seemingly toxic states of pain and rage) with just as much power. In fact, over the past couple of decades, almost all psychoanalytic writing about what is curative in therapy stresses relationship aspects of the treatment experience over traditional notions of insight.”

McWilliams concludes, “The analytic emphasis on understanding is partly attributable to the fact that the two participants in the work need something interesting to talk about while the nonspecific factors are doing their quiet healing.” (p. 15)

Group Therapy

Group therapy can be a powerful intervention when it comes to healing shame. I sometimes say to a patient, “In childhood you were brainwashed into believing that there was something wrong with you.” Implicit in the excruciating feeling of shame is the sense that “others can see that I am flawed or damaged.” Group therapy offers a wonderful opportunity to “test out” this belief, and over time one is able to let go of the “brainwashing” by experiencing through group members reflections and empathy and care that one is not the flawed person one has so long believed oneself to be.

Dr. Elan Golomb, whose book, Trapped in the Mirror: Adult Children of Narcissists in Their Struggle for Self, helped inspire me to start a group for women with deep shame wounds from childhood, writes, “Where and how can we see ourselves at all? We need a reliable mirror in which to look, to be accepted as we are, to achieve a sense of being…Group therapy is often useful…Out of our terror, we learn to speak our minds. We start to feel our temper…We find that we have identities of our own…We learn that there is someone inside us…In group, you find out that you are not the only one with a hideous self-image that was put in place by endless parental demands for change.” (pp. 220 & 245)

One group member, after 10 years in my group, called me as she was leaving Nashville to relocate to the Northeast. “I wanted to call you,” she said, “to tell you that this group changed my life.” Over time, group members keep other group members in their mind throughout the week, as a kind of supportive inner chorus. Recently one member talked about how she gets through a challenging week: “I tell myself,” she says, “that I just need to make it until Tuesday night.”

Meditation and Buddhist Psychology

Meditation and Buddhist psychology and concepts can be enormously helpful for patients with deep shame wounds. What perpetuates shame is one’s own inner voice of judgment and criticism—one’s “inner critic.” Mindfulness mediation provides a method for dislodging and uprooting the inner critic. Through regular meditation practice, the mind develops a kind of non-judging muscle, as, over and over, when the mind drifts off during meditation and gets busy thinking, we non-judgmentally bring the mind back to the breath. As Jack Kornfield has written in A Path With Heart, “We discover a remarkable truth: much of spiritual life is self-acceptance, maybe all of it.” (p. 47)

One of the most profound aspects of Buddhism is its emphasis on non-judgment. This is a powerful antidote to shame. When the concepts of shame and low self-esteem were first introduced to the Dalai Lama, he could not understand these concepts, as he had never encountered them in all his Buddhist studies and meditation. The Buddha is often quoted as saying, “You could search the whole world over, and not find a single person more deserving of lovingkindness and compassion that you yourself.”

The emphasis in Buddhist psychology is on developing an observing mind that is able to choose healthy thought patterns and let go of unhealthy ones. Certainly, the inner critic is one of those unhealthy thought patterns. Another is what Sharon Salzberg, in her wonderful book Lovingkindness, calls “the comparing mind.” She writes:

“Comparing ourselves to others is a very powerful mental affliction. In Buddhist psychology it is called ‘conceit.” When we are enmeshed in conceit, we are pulled outside ourselves, trying to know who we are and what our experience is by comparing ourselves to others. ‘Who am I in reference to that? Am I good enough in comparison to that?’”

“Whether we conclude that we are better than, worse than, or equal to another, when we measure ourselves against others, it causes us harm. As we constantly try to decide, through comparison with others, who we are, what is important about us, whether or not we are happy, that churning of the mind in itself undermines our happiness. Comparison or conceit is a gnawing, painful restlessness. It can never bring us to peace, because there is no end to the possibilities for comparison.” (p. 122)

I introduce many patients, especially those dealing with deep shame wounds, to “metta,” which is Buddhist lovingkindness practice. In this practice, one develops phrases that one repeats to oneself on a daily basis, such as, “Lovingkindness and compassion towards myself. May I be free from suffering, free from ill will. May I be happy. May I love myself completely, just as I am.” Lovingkindness practice can be a wonderful antidote to the inner critic voice. I suggest to patients that the goal is to replace the inner critic with a stance of self-regard and self-acceptance.

In conclusion, I will quote from a session with the 41-year-old patient mentioned earlier, in which he said to me, “I’m reading a great article in the Buddhist magazine The Lion’s Roar.

I want to be this way. I want to be a student of these concepts—wherever that will lead me. A way to live in the world—there’s no other way that I’ve seen, without doing self-harm.”