The wind blew in strong gusts, howling and shaking the windows. Tracey pulled her cardigan tighter, then rubbed her arms with her hands. “I hate strong wind. It feels like the walls are going to come down.”
Interesting, I thought, we’re getting closer. This described exactly what was happening in the room.
Tracey and I had been working together for four months but had barely scratched the surface. She discussed work-related stressors and dating. She would go into detail about the many men she dated, but she never described her feelings. I wanted to know more about her inner life, but I felt her guardedness. She had a wall up. And I had to respect it.
Walls are fears disguised as safety.
But why are they there in the first place? When patients come in, but have trouble disclosing, this is the question.
We call it defensive structure or defensive mechanisms or resistance, this wall. We have words, but one I rarely hear that is significant, is shame. My dissertation topic involved a thorough analysis of shame and I have continued my research. Every time I’ve presented on the topic, students and established clinicians alike ask the same question: “Why aren’t we having classes on shame?” It’s important.
Shame is the deepest and most painful affect, as it involves an evaluation of the entire self. Whereas guilt assesses what we do- “I shouldn’t have done that”, for example; shame evaluates the entire self: “I shouldn’t be that.” Guilt says, “what I did is bad.” Shame says, “I am bad.” Shame pervades our sense of self – entirely.
Shame also involves the real or imagined perception of another. It’s the reason why infants and toddlers will run around nude without feeling exposed. They haven’t reached the developmental stage where they recognize themselves in the eyes of others.
The essence of psychotherapy requires that patients come in and reveal their innermost self, layers of secrets, elaborate fantasies. We are asking them to tell us the very thoughts and feelings that are usually hidden, because we don’t want others to see. Shame inevitably arises as the bricks come down and the patient feels exposed.
For patients like Tracey who have never been in psychotherapy before, this is often even more difficult. Additionally, unresolved shame creates more psychotherapeutic challenges. Unresolved shame (which I will discuss in the next blog), develops when injuries to the self occur over and over; any type of emotional abuse will leave people with some unresolved shame, which is woven into the very fabric of their identity.
In a lecture I had given some time ago, a psychodynamic student asked if I thought it was our own shame that made us avoid discussions of shame. I hope not. We need to afford patients the luxury of a safe room, where we are sensitive and cognizant of the shame that naturally arises as disclosure increases.
I had to help Tracey feel safe enough to slowly remove the bricks she felt were loosening. I went with the metaphor. “What do you imagine would happen if the walls came down?”
“I dunno.” She crossed her arms tighter.
“Are you feeling that right now, like the walls are coming down?”
She diverted eye contact, picking at a string on her shirt. “I don’t want you to think I’m crazy. I feel crazy sometimes.”
I leaned forward. “I know this is hard. Everyone that comes in here feels like their thoughts are crazy. I have thoughts sometimes that others might think were crazy. It’s normal.”
She looked back at me. “You do? But you’re a doctor.”
“We all have ideas and thoughts and fantasies that feel bad or scare us sometimes.” Small self-disclosures to normalize the situation and show patients that we are also vulnerable to emotions helps ease shame-ridden angst. Also, keeping the dyad collaborative instead of hierarchal reduces shame.
“I have thoughts like that all the time.” She placed her hands over her face. “There are things that I’ve never told anyone before. I know I should tell you, but it’s very hard.”
“I know it is. Maybe we can start with what you’re afraid I will think.”
“OK,” she said with a small smile. I felt a few bricks had come down as I acknowledged her shame. I knew that the more we discussed her fear, the safer she would feel to explore what was behind the wall. It would be two bricks down, one back up, but at least we were finally at a start.
*Tracey is an amalgamated example of patients during early sessions struggling with shame.
File under: The Art of Psychotherapy
Interesting, I thought, we’re getting closer. This described exactly what was happening in the room.
Tracey and I had been working together for four months but had barely scratched the surface. She discussed work-related stressors and dating. She would go into detail about the many men she dated, but she never described her feelings. I wanted to know more about her inner life, but I felt her guardedness. She had a wall up. And I had to respect it.
Walls are fears disguised as safety.
But why are they there in the first place? When patients come in, but have trouble disclosing, this is the question.
We call it defensive structure or defensive mechanisms or resistance, this wall. We have words, but one I rarely hear that is significant, is shame. My dissertation topic involved a thorough analysis of shame and I have continued my research. Every time I’ve presented on the topic, students and established clinicians alike ask the same question: “Why aren’t we having classes on shame?” It’s important.
Shame is the deepest and most painful affect, as it involves an evaluation of the entire self. Whereas guilt assesses what we do- “I shouldn’t have done that”, for example; shame evaluates the entire self: “I shouldn’t be that.” Guilt says, “what I did is bad.” Shame says, “I am bad.” Shame pervades our sense of self – entirely.
Shame also involves the real or imagined perception of another. It’s the reason why infants and toddlers will run around nude without feeling exposed. They haven’t reached the developmental stage where they recognize themselves in the eyes of others.
The essence of psychotherapy requires that patients come in and reveal their innermost self, layers of secrets, elaborate fantasies. We are asking them to tell us the very thoughts and feelings that are usually hidden, because we don’t want others to see. Shame inevitably arises as the bricks come down and the patient feels exposed.
For patients like Tracey who have never been in psychotherapy before, this is often even more difficult. Additionally, unresolved shame creates more psychotherapeutic challenges. Unresolved shame (which I will discuss in the next blog), develops when injuries to the self occur over and over; any type of emotional abuse will leave people with some unresolved shame, which is woven into the very fabric of their identity.
In a lecture I had given some time ago, a psychodynamic student asked if I thought it was our own shame that made us avoid discussions of shame. I hope not. We need to afford patients the luxury of a safe room, where we are sensitive and cognizant of the shame that naturally arises as disclosure increases.
I had to help Tracey feel safe enough to slowly remove the bricks she felt were loosening. I went with the metaphor. “What do you imagine would happen if the walls came down?”
“I dunno.” She crossed her arms tighter.
“Are you feeling that right now, like the walls are coming down?”
She diverted eye contact, picking at a string on her shirt. “I don’t want you to think I’m crazy. I feel crazy sometimes.”
I leaned forward. “I know this is hard. Everyone that comes in here feels like their thoughts are crazy. I have thoughts sometimes that others might think were crazy. It’s normal.”
She looked back at me. “You do? But you’re a doctor.”
“We all have ideas and thoughts and fantasies that feel bad or scare us sometimes.” Small self-disclosures to normalize the situation and show patients that we are also vulnerable to emotions helps ease shame-ridden angst. Also, keeping the dyad collaborative instead of hierarchal reduces shame.
“I have thoughts like that all the time.” She placed her hands over her face. “There are things that I’ve never told anyone before. I know I should tell you, but it’s very hard.”
“I know it is. Maybe we can start with what you’re afraid I will think.”
“OK,” she said with a small smile. I felt a few bricks had come down as I acknowledged her shame. I knew that the more we discussed her fear, the safer she would feel to explore what was behind the wall. It would be two bricks down, one back up, but at least we were finally at a start.
*Tracey is an amalgamated example of patients during early sessions struggling with shame.
File under: The Art of Psychotherapy