Presentation on theme: "Shame, Pride and Psychotherapy with Children and Adults"— Presentation transcript:
1Shame, Pride and Psychotherapy with Children and Adults Ken Benau, Ph.D.Ann Martin CenterMay 18, 2012
2Why are shame and pride important to psychotherapy? Shame is important because:Shame negatively impacts one’s psychological, interpersonal and overall life functioning, more so than guilt.People feel shame seeking therapy, and when revealing their core issues.If shame is not directly addressed, therapy will stall or fail; pt will feel misunderstood, terminate prematurely, remain emotionally distant, etc.Personally: lower self-esteem, depression, suicidal ideation, anxiety, eating disorders, substance abuse, PTSD. By contrast, shame-free guilt is “unrelated to psychological symptoms” (cf. Self-conscious emotions, p.27).Interpersonally: lowered empathy, increased anger, hostility, aggressive behavior .Shame is ubiquitous in therapy, because it is fundamentally about the self, and self-in-relationship. Vitally important for patient, therapist and patient-therapist dyad alike .Shame and how to identify and work with it is not usually taught in graduate school.Patients avoid it (consciously and unconsciously); remains hidden unless therapist can identify it (e.g verbal and nonverbal markers. A brief clinical example.
3Why are shame and pride important to psychotherapy? Pride is important because:Presumably self-esteem, interpersonal relationships, overall life functioning, physical and mental health all improve when patient experiences genuine pride.Increased capacity to fully participate in therapy and life (increased interpersonal engagement; opposite of withdrawal).Patient feels seen, validated, affirmed; viewed as whole person, not just his or her “problems” or “deficits”.Gives pt hope, sense of what’s possible (experientially); helps maintainmotivation throughout “tough times” of therapy (“dark nights of the soul”).Therapy is not merely about alleviating the patient’s shame, but also enhancing their genuine pride.
4 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Model of optimal arousal: Hyperarousal ______________________________________ Window of optimal arousal _______________________________________ Hypoarousal
5Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Dysregulated, inauthentic or “pathogenic shame” is the shame that debilitates and destroys. It is the feeling that there is something horribly wrong with you, and if you deserve to live you certainly are not worthy of living with other decent people who are acceptable. This is the shame that leaves you feeling inferior and, at times, disgusted with yourself and filled with self-loathing.(cf. Handout 1)Inauthentic or pathogenic shame is also fueled by fear and infused with self-directed anger and disgust. In what may appear paradoxical at first glance, the fear that propels inauthentic shame is the fear of losing one’s connection with the shaming other, or the social group s/he represents.Out of love and respect for the shamer (and sometimes fear as well), and a deep human need to be part of rather than banished from the other’s heart and mind, inauthentic shame arises in a valiant, intrapsychic attempt to:Silence the true self in the hopes that, at a minimum, an inauthentic self (“false self”) will be accepted; andSquelch any anger that might protest or challenge the shamer’s attack or dismissive behavior, and redirect it toward the true self experience (i.e. thoughts, feelings and behavior).
6Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Pathogenic shame follows the “Wiley Coyote” 4-step model of arousal:Step 1: ShockThe person is either shamed (or brings to consciousness a shaming event, thought, feeling, etc.), resulting in a spike in arousal (hyperarousal). There is an initial startle, shock or jolt of energy, often associated with fear and a momentary “freeze” response, and always associated with an orienting response toward the “shaming stimuli”. This is Wiley Coyote frozen in midair, realizing there is no ground beneath him.Step 2: DropA rapid downregulation of arousal, what Tomkins refers to as the “braking” function of shame. This is Wiley Coyote falling down, down, down to the ground, causing a “sinking” feeling.Step 3: Shame ProperA state of hypoarousal where one feels a loss of energy, motivation, drive, interest, etc., and also feels worthless. This is Wiley Coyote having hit the ground with a terrible thud—splat. For some, the shame experience is either repeated or unrelenting, which is both overwhelming and unbearable.Step 4: DissociationWhat results is the person becomes dissociated (i.e. numb, disconnected, depressed, etc.). Wiley Coyote is now splayed flat on the ground, and not able to recover for some time.
7Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Well-regulated, authentic or “self-righting” shame:In the lower end of “window of optimal arousal”. It is “self-righting”, in that the person uses the experience to realign with their personal or communal values.In self-righting shame, the individual recognizes from a non-reactive, non-defensive, accepting and mindful place, that they have not been true to themselves and their values.This is not the shame associated with failing to meet unreasonably high standards of perfection. Rather, this is the feeling that comes when one realizes that one is “off course”, i.e. being or behaving in ways that feel “false” or “untrue” to one’s core sense of self.While some have referred to this phenomenon as “existential guilt” (cf. Otto Rank), I prefer to think of it as “existential shame”, because the feelings are about one’s whole being, not merely one’s ill-considered actions.To paraphrase a patient of mine , “I didn’t live up to what I know I am capable of, and how I want to be with others. I don’t feel crushed or like I don’t deserve to exist [as he typically felt when in the grips of pathogenic shame], but I do feel shame nonetheless. I want to be better next time”.(Cf. Handout 2)
8Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Well-regulated pride, also known as “authentic”, “genuine” or non-hubristic prideIn the upper end of arousal.Allows the person to take pleasure in oneself and one’s accomplishments, while remaining relational (i.e. empathic toward and accepting of others).
9Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Some definitions and word origins consistent with “authentic pride”:Genuine, authentic, or well-regulated pride is, by contrast, closer to these definitions and synonyms.A feeling of pleasure for one’s own achievements… self-respect (Dictionary.com).A sense of one’s own proper dignity or value. The most successful or thriving condition (Answers.com).Consciousness of one’s own dignity (Oxford Dictionary online).Delight or elation arising from some act, possession or relationship (Merriam-Webster).
10Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic pride Word origins get us even closer to the heart of “authentic pride” as relates to our work as psychotherapists:Before 1,000 AD, Old English “pryde” or “prythe”, meaning “bravery” or “pomp”; a derivative of “prud” (Dictionary.com).Old English “prud” Old French “prou”, meaning “proud”, “brave” or “virtuous” Late Latin “pride”, meaning “advantageous” Latin “prodesse”, “to be good”, from “prod” meaning “for”, and “esse”, meaning “to be” (Answers.com).
11Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic pride Authentic (non-hubristic) pride, following word origin:Being “pro” or “for” one’s “being” or “essence”.Taking pleasure in oneself, or “joy in being” and in one’s own aliveness.Much deeper than feeling proud of an accomplishment. Rather, it is the deep satisfaction or pleasure derived from feeling how I am, what I do, and yes, even what I achieve, expresses a deeper truth of my being.It is “me” or “my best or truest self”, “my soul” bursting forth, given voice and embodiment.Pride’s energy pulses throughout our body. When people feel genuine pride, their chest expands, they feel more spacious in their upper core, and they breathe more easily—that is, their essence or being, is liberated.
12Dysregulated, inauthentic or “hubristic pride” : Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic prideDysregulated, inauthentic or “hubristic pride” :Falls within hyperarousal, unless it is ego-syntonic (as in a Narcissistic Personality Disorder).This is pride that begets arrogance, and becoming dismissive, disdainful, sometimes even disgusted with the other person.Think Mussolini with his arms crossed, chin and lower lip out, looking out his balcony in Rome during the height of his rule; cf. Video.
13Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic pride Definitions consistent with “hubristic pride”:Arrogance, haughtiness, vanity, conceit (Dictionary.com)Disdainful conduct or treatment (Answers.com)Inordinate self-esteem (Merriam-Webster)
14Further distinctions between shame and pride Handout 3: “Some Phenomenological Distinctions between Authentic and Hubristic Pride: Part 1” Handout 4: “Some Phenomenological Distinctions between Shame and Pride: Part 2” Handout 5: “Narcissism/Arrogance-- Pride/Admiration--Shame/Envy Continuum”
15Differentiating Shame and Guilt Shame (pathogenic shame): I am bad. Soul-ar eclipse. Invites isolation, rejection of self or other. A primitive form of restoring the social order.Guilt: I did something bad, that I regret. Dark spot on the moon. Invites reparation, restitution, and re-connection.As Paul Ekman writes, “The distinction between shame and guilt is very important, since these two emotions may tear a person in opposite directions. The wish to relieve guilt may motivate a confession, but the wish to avoid the humiliation of shame may prevent it”.“The difference between guilt and shame is very clear—in theory. We feel guilty for what we do. We feel shame for what we are.”Lewis B. Smedes, Shame and Grace
16Clinical Significance of differentiating pathogenic shame and guilt In short, pathogenic shame debilitates and must be worked with so that the patient can either experience:self-righting shameorguilt and reparative action.
17Transforming pathogenic shame into self-righting shame or guilt Turning towardIntra-relational, followed by inter-relational repairDyadic regulation, followed by inter-relational repairPsychoeducationMindfulness
18Developmental theories of shame Traditional theory: Age 2 ½ to 3 years old. Cognitive capacity to perceive that others are evaluating your behavior. (“I can tell that you are judging me negatively, and I judge myself too, and feel shame”).Limitations of traditional theory: Based on cognitive and verbal capacities, and less on feeling and pre-verbal experience.Non-traditional theory: Precursors of shame develop during the first year of life.
19Developmental theories of shame and pride [Infants] "… may never be quite alone, may always be expecting to be active under real or imagined scrutiny by the attention of others, but should not wish to be dependent on their will. Infants are born with a bold self-consciousness of this kind; one that soon takes responsibility for independent acting and thinking, but that may also feel pleasure and pride in the approval of others, and shame at failure before them", p. 56, (emphasis mine).from Trevarthen, C. (2005). "Stepping away from the mirror: Pride and shame in adventures in companionship-- Reflections on the nature and emotional needs of infant intersubjectivity", in Carter, L., Ahnert, K.E., Grossman, S.B., Hrdy, M.E., Lamb, S.W., Porges, S., & Sachser, N., (Eds.). Attachment and bonding: A new synthesis. Cambridge, MA: MIT Press, pp
20Developmental theories of shame and pride "The needs for sociability, even for the newborn, go beyond seeking regulation, care, protection, stress-regulation, etc., that the internal body needs. Bodies are active mind-driven agencies; there is a need for support of interests or `purposes and concerns' (Donaldson 1992)", p. 69 (emphasis mine).from Trevarthen, C. (2005). "Stepping away from the mirror: Pride and shame in adventures in companionship-- Reflections on the nature and emotional needs of infant intersubjectivity", in Carter, L., Ahnert, K.E., Grossman, S.B., Hrdy, M.E., Lamb, S.W., Porges, S., & Sachser, N., (Eds.). Attachment and bonding: A new synthesis. Cambridge, MA: MIT Press, pp
21Developmental theories of shame Still-face paradigm (Tronick) and its relevance to the earliest precursors in the development of shame and prideClinical relevance of the theory of development that situates shame and pride at the preverbal levelReminds us to pay attention to the shame that results when a person’s significant other, including the therapist, is “still faced” or non-responsive. Shame results from both active shaming (“You loser!”), and passive shaming (significant other is non-responsive).Requires the therapist to be trained in approaches that are more emotion-focused, attachment-focused (moment-to-moment tracking), and somatic-focused, i.e. working with the body and not just words.
22Shame and its manifestations in children and families Internalizing formsInhibition: Fear of trying new things; clinging: “Reassure me that I’m not bad”, while at the same time not being able to accept the reassurance because they feel they must be bad.Social anxiety: “They’ll make fun of me”; “They won’t like me and I’ll have no friends”.Social isolation: WithdrawalPerfectionism: Child can’t reveal or admit mistakes or vulnerability.Depression: Including shutdown, withdrawal, indecision (associated with the neuropsychology of shame, where speech centers “shut off” and person can’t “think straight”.
23Shame and its manifestations in children and families Externalizing formsActing out, disruptive behavior: In class, student prefers to be perceived as “bad” rather than “stupid”. Within their family, child prefers to be perceived as “bad” rather than “unwanted”, a nobody nothing.Bullying, aggression: (“I will hurt you before you hurt me”). Domineering and shaming others in an effort to feel powerful and worthy.
24Shame and its manifestations in children and families Content of shameEverything that makes a kid “different” in a negative or less capable way, about something that matters to the child and/or parents, at that point in the child’s development, such as:Age appropriate skills (e.g. sports, riding bike, putting on clothes, toileting, eating, speaking, interacting, etc.)Academic abilities and LD.Social abilities with peers, and NLD, Asperger’s, social anxiety.Social abilities with family: e.g. separation from parents , going to school, age-appropriate independence.
25Attachment style and its relationship to shame in children Insecure attachmentAnxious or preoccupied style: critical, judgmental, demanding, shaming, or anxious parent who overprotects child. Parent avoids real problems out of fear child will feel shame or “bad about themselves”. E.g. ADHD father of ADHD child, who says there is “no problem”, because to “fix it” would mean the “child” and by extension the parent, will feel shamed.Avoidant style: non-responsive, depressed, emotionally distant, and/or quietly dismissive parent.Disorganized style: frightening parent freeze response (can’t think or feel) child collapses into pathogenic shame.
26Shame and its manifestations in adults Research shows shame (more than guilt) is associated with a host of psychological symptoms, disorders, and problems in interpersonal relations. Shame is “causative” to a host of problems, but it is also the effect of having these problems.
27Shame and its manifestations in adults Internalizing formsInhibition, anxiety, social anxiety, social phobias. (Shamed self avoids social contact, and then further shames self for social difficulties).DepressionPsychosisSubstance abuse, alcoholism (primary/causative and secondary/effects)
28Shame and its manifestations in adults Externalizing formsShaming others: e.g. Narcissistic Personality DisorderAggressive acting outBipolar: dysregulated sense of self (worthless/grandiose)Over-activity: distract self from painful emotions, especially shame
29Shame and its manifestations in adults Interpersonal functioningMarital, family, work-related. E.g. keep distance, hide true self don’t trust and are not trusted by others, which further exacerbates problems.Grandiose, dismissive, arrogant defenses against shame, expressed toward colleagues, spouse, children, etc.
30Shame and its manifestations in adults Gender and shameMen: stereotypically more concerned with functioning at work; status; power; money; being able to provide for family> parenting.Women: stereotypically more concerned with weight, eating disorders; appearance; parenting> providing; peer relationships.Both genders: concern with status, prestige, inclusion/exclusion within social circle and community.
31Shame in therapy: How it actually appears in therapy Overt/Explicit/Direct Manifestations (less common)Verbalization: “feel like crap”, “depressed”, “worthless”, “loser”, “no one likes me”, “no one wants/needs me”, “feel like an imposter”.Ego-syntonic: I am worthless and don’t try to convince me otherwise. Patient rejects or dismisses all praise, with remarks like, “You have to say that, you’re my therapist”. (These patients are less likely to seek therapy, or at least to state explicitly they need help with feelings of shame).Ego-dystonic: “I feel worthless, even though I know I’m not”. This can be understand as a discrepancy between the patient’s conceptual/neo-cortical parts of the brain, and the “participatory” or “procedural knowing”, or “limbic” and arousal system.
32Shame in therapy: How it actually appears in therapy Covert/Implicit/Indirect Manifestations (far more common)Behavior: Withdrawn, isolated, depressed, dissociated/numb, depersonalized. Empty, dissociated, “Just talking”, talk.Social anxiety, inhibition, fear/freeze response (to avoid overt shaming/rejection).Upregulation strategies to manage shame: overwork, over-socialize, distractions, “driven”, etc.Downregulation strategies: Numbing: drugs/alcohol, sleep, etc.Nonverbal presentation: avert eye gaze (down, to side); head down; covering gestures; blushing; dissociation; decreased energy; diminished motivation.Defensive, rage reactions in response to perceived/anticipated narcissistic injuries, slights, criticisms, etc.Shame as defense against unwanted emotions, thoughts, behaviors (e.g. sex, anger/aggression, etc.)Lack of progress in therapy, especially if haven’t addressed shame directly, in the here and now, and in the relationship (Bromberg, p. 154, STH).
33Working with shame and pride in therapy: Children Psychoeducation and social skills instructionParts work and mindfulness: Cultivating curiosity, compassion, and acceptance toward different “parts” or aspects of self-experience.Coherence therapy (formerly known as “Depth-oriented Brief Therapy”-DOBT): Via radical empathy, helps the patient contact the unconscious, emotional truth that supports their “symptom” (pro-symptom position), despite their consciously held, “anti-symptom position”. Then experientially juxtaposes the two.Relational work: Making explicit to child the ways in which you “see” and “value” them.Peer and social support : Helping child or adolescent patients find their social niche.Family: Helping child and parents become aware of certain family legacies associated with shame.
34Working with shame and pride in therapy: Adults Sensorimotor psychotherapy (SP)Mindfulness and Parts workMoving between the inter-personal and intra-personal experience of shame: Using portrayals with part-self experienceAEDP (Accelerated Experiential-Dynamic Psychotherapy)Basic premises of AEDP: Undoing aloneness; dyadic regulation; affect processing focus; affirmation, strength based; creating a secure attachment; moment-to-moment tracking of emotional and somatic experience; bottom-up processing; moving from Defense (state 1), to Processing Core Affect (state 2), to Transformational affects and Metaprocessing of change (state 3), to Core State (state 4).
35Working with shame and pride in therapy: Adults Video demonstration and discussion: “Jake”
36Contact InformationKen Benau, Ph.D. 376 Colusa Avenue, Suite #2 Kensington, CA (510) For information about joining my blog: “Shame, Pride and Psychotherapy”