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The SSC Blog entitled Shame (Part 1): Surfacing from its Hiddenness (accessible at https://www.safespacecom.org/post/shame-part-1-surfacing-from-its-hiddenness) stated four real cases of psychological problems which can be traced back to shame as the root cause. Anne, a final-year university student, is still depressed after seeing a psychiatrist and a student counselor for over one year. Another lady by the name of Patty has been for years repeatedly washing her hands as a compulsive behavior after going to the toilet or bathroom. On the other hand, Norman often physically abuses his wife at home. Another man called Alex is addicted to gambling and his family is on the verge of breaking up.
Like the above four cases, people usually come into therapy complaining of their maladaptive or dysfunctional behaviors without a clue that it is the unconscious and habitual overuse of a certain defense mechanism to suppress their hidden shame from surfacing that eventually gives rise to those behaviors. Subsequently, shame-informed psychotherapy is applied following or alongside contemporary evidence-based counseling modalities and protocols to address the presenting psychological problems. In other words, shame-informed psychotherapy is used only as a supplementary intervention and not as a replacement for first-level interventions. Addressing shame this way is more appropriate because most people do not seek professional help merely over their shame but over some other psychological manifestations. After or at some stage of the intervention process in helping the client work through and cope with the external symptoms using the therapist’s most favored approaches, he or she will then focus on addressing the underlying shame. The sequence is better understood when we look at the following descriptions of the above four cases in greater detail.
The case of Anne (depression)
I was once referred a very depressed student named Anne who could not continue with her final year studies in Astrophysics at an American university. That was after seeing a psychiatrist and a student counselor to help her cope with depression for one whole year before her father persuaded her to give up everything and come back home.
While attending to her depression, I also discovered that in her school days, she was constantly shamed by her teachers for not completing her homework. To avoid further exposure to shame, she had set very high expectations on herself. At the same time, she became extremely shy even to the extent of avoiding to ask questions about what she did not understand. Unfortunately, she came to a breaking point in her final year when she could not catch up with her studies and her mind went totally blank.
Besides addressing her depression with cognitive behavioral therapy techniques, I also attended to her shame, freed her from her withdrawals, and restored her confidence. She eventually recovered from her depression, went back to her studies, and successfully graduated from her course.
The case of Patty (compulsive behavior)
I once treated a client named Patty who compulsively washed her hands many times after going to the toilet or bathroom. I initially tried using exposure and response prevention techniques on her but this only helped her to cope superficially with her compulsive behavior without getting to the root of her problem.
I eventually learned that when she was a child, she perceived that her father molested her and she grew up ashamed of her “dirtiness”. Whenever she touched her underwear, she would feel dirty and so she constantly washed her hands to get rid of the dirtiness as a form of self-punishment.
To bring about the structural change at the level of her core beliefs and early memories, I attended to her shame by bringing her back to the original incident of the “sexual abuse”, led her through an emotional reframing experience, and finally delivered her from her shame and compulsive behavior.
The case of Norman (physical abuse)
I once counseled a couple of which the wife Cindy was often abused physically by her husband called Norman. Couple therapy techniques like reframing, reappraisal, and empathy-based collaborative alliances as well as anger management strategies had made some but limited difference to the ongoing violence.
After some time, I began to focus on the man’s shame. I found out that as a child, his parents used to shame him for not doing as well as his younger sister in their studies. He grew up with a high sense of inferiority toward younger women and each time he felt insulted or disrespected, whether in the family or at work, he would take it on his younger wife.
I gave him the insight into what made him “attack-other” as a defense against his own shame and helped him embrace the truth that his self-worth is not based on how other people see him but on what he is as a unique individual who is no less than anyone else. After the intervention on shame, their marriage had improved remarkably without further incidences of domestic violence.
The case of Alex (addiction)
Alex was brought to me for counseling by his wife as he was addicted to gambling and the family was on the verge of breaking up. I initially utilized the normal evidence-based intervention protocols which included cognitive restructuring and financial/time management training (Cognitive Behaviour Therapy) as well as imaginal desensitization techniques (Behavioural Therapy). Alex eventually stopped his gambling activities but he complained that he had to exercise a lot of effort and willpower to manage his urges and he desired to be set free more completely.
I explained to him that ultimately, his addiction is a form of escape and distraction from the overwhelming shame built-up since his childhood days. It is a substitute for relationships and a way to avoid intimacy and closeness due to the lack of relational worth. Alex then revealed that when young, he constantly experienced shame as he was placed by his widowed mother under the care of a domestic maid who had often rejected and abandoned him.
After the supplementary intervention on shame, Alex reported that he sensed he had a genuine breakthrough from his gambling urges.
The neuroscience aspects of shame
Our acute shame is internalized and stored in our memories. Memories are formed by the reactivation of a specific group of nerve cells called neurons through the persistent changes in the strength of connections between them. The persistent change in the strength of the connections is termed as synaptic plasticity. Neurons that fire together wire together.
Past toxic shame memories can be restructured through the creation of healthy reparative memories as alternative routes for the synapses to travel on when shame is triggered. The good news is that we can create healthy alternative routes without reliving those events in real life.
Indeed, neuroscience researchers have found that mental imagery can change our multisensory perceptions. In other words, our imagination can create reality at the neuronal level. To be effective, shame memory reframing through imagery has to be experienced as real as possible. The “experiencing” is key for effectiveness.
The process of resolving hidden shame
Based on the latest findings in neuroscience, hidden shame can be resolved in shame-informed psychotherapy using the following process:
Step 1: Focus on the symptomatic intervention of the presenting problems to relieve the suffering.
Step 2: Surface the shame from its hiddenness by helping the client to be more aware of how they react in the face of shame (see Shame (Part 1) of the SSC blog).
Step 3: Connect the symptoms to the defense strategy.
Step 4: Get the client to relax, close his eyes, and imagine walking into his past memories.
Step 5: Select one original acute shame incident (governing scene).
Step 6: Re-experience the governing scene as real as possible and verbalize the sequence and emotions embedded in the memory.
Step 7: Ask the client to imagine bringing into the governing scene someone who can rescue him from his acute shaming incident.
The purpose is to repair the shame of his original experience to create through imagery a favorable memory out of the same past shame scene as an alternative route for the memory synapses to travel.
20 Sep 2022
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