Have you ever been so ashamed about something you've done, said, or thought that you avoided talking about it with anyone? Even your therapist?
Even in good relationships, with people close to you, you may omit or change a story because of the shame you feel. So, it's understandable that you might do that when working with a therapist. Research suggests that two-thirds of clients leave things out during psychotherapy. People often find it difficult to talk about relationship difficulties, sexual issues, or feelings of failure. And, of course, their therapists don't know what has been left unsaid. Unfortunately, omitting information obscures an important part of who a person is and can impede their progress in therapy.
Shame, Guilt, and Embarrassment
Shame is a powerful force with deep roots in our specie’s history and in every childhood. When we feel ashamed we become so self-conscious that we are often immobilized, unable to think clearly, and/or act normally. In pre-historic times, shame helped keep social groups cohesive and safe — anyone breaking the rules was shamed. Shame disciplines because it so painful an emotion that we try to avoid it at all costs. Today, children are often shamed as a way to get them to conform to parents' or institutions’ expectations and social groups ensure conformity by shaming transgressors.
Shame is not the same as guilt. Here's the difference: Guilt is feeling that you did something bad. Shame is feeling that YOU are bad. In contrast to guilt, which is associated with behaviour, shame is associated with your self. That's one reason shame is so painful: it is closely wrapped up with your sense of self-worth.
And don't confuse shame with embarrassment. You might be embarrassed because you dropped a plate of food on the floor at a party. But the experience is usually fleeting. You may have felt embarrassed but others have too, and it's soon forgotten. Shame is deeper. When you cannot shake the feeling, not that you were embarrassed for a moment, but that you are bad or worthless — that is the deep, debilitating emotion of shame.
Shame in Therapy
Shame shows up in therapy in many ways. When revealing things about yourself, you'll inevitably have thoughts, feelings, and memories that you are ashamed of. Therapists recognize that these feelings are hard to talk about. Some people are more prone to shame than others, possibly after having been shamed excessively during childhood. A deeply internalized, pervasive fear of shame may express itself in indirect ways — a person may becoming controlling and aggressively shame others to mask their own insecurity, or become a perfectionist to avoid any chance of feeling shame again. Tragically, trauma can manifest itself in shame as the victim takes the blame and the shame for the behaviour of others onto themselves. And shame may be linked to anxiety, as someone who is shame-prone approaches much of their life in fear of being shamed.
Just as it might be difficult for you to talk about things you are ashamed of, it can be difficult for a therapist to get at a patient's shameful thoughts and feelings. No one likes to cause pain to others and exposing shameful thoughts and feelings is certainly painful. So while it is difficult work to do, therapists and patients must work collaboratively to explore these difficult and painful thoughts and feelings. Oftentimes, starting a dialogue about why shame is difficult to talk about and what shame means to a patient can be very helpful at starting to process the feelings of shame.
Getting the Most from Therapy by Opening Up
But ultimately it's best for you and for the course of your therapy if you accept and examine sources of shame. There is evidence that when clients don't talk about things that are important to them, the outcome of the therapy is not as positive. On the other hand, when patient and therapist bring shameful thoughts out into the open, there is great potential for healing. Simply expressing shame can often be therapeutic in itself. Acknowledging that it is normal to feel shame can bring tremendous relief. Gaining insight into its origins and triggers leads to self-acceptance and practical coping techniques to manage shame.
One thing we know for certain is that a solid, trusting relationship between patient and therapist is the key to successful therapy. Hiding shameful thoughts during therapy can hinder the therapeutic relationship while opening up about those painful feelings only strengthens the relationship and encourages a patient’s healthy transformation.
Written by: Avi Soudack, M.A.
Edited/Reviewed by: Dr. Stacy Lekkos, C. Psych
References
Dearing, Ronda & Tangney, June. (2011). Shame in the Therapy Hour. American Psychological Society. https://doi.org/10.1037/12326-000
Farber, B. A. (2003). Patient Self-Disclosure: A Review of the Research. Journal of Clinical Psychology, 59(5), 589–600. https://doi.org/10.1002/jclp.10161
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