Shame, Guilt, and Alcoholism

Treatment Issues in Clinical Practice, Second Edition

Ron Potter-Efron, Bruce Carruth

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780789015174
• eBook ISBN: 9781317788508
• Topic: Psicología
• Subtopic: Adicción en psicología

Explore the causes and effects of the shame/guilt/addiction cycle!Since the original edition in 1989, great strides have been made in understanding the overlapping functions of shame and guilt and the ways these painful emotions are linked with addictions. Shame, Guilt, and Alcoholism: Treatment Issues in Clinical Practice, Second Edition, integrates up-to-date psychological research with penetrating insight into the emotional realities of substance abuse. It provides a clear and practical model for understanding the shame/guilt/addiction cycle.Shame, Guilt, and Alcoholism provides constructive suggestions to therapists for treating substance-abusing clients and their affected family members. By treating destructive, inappropriate, or excessive shame and guilt, therapists can help their clients free themselves from the downward spiral of addiction and begin to build on their genuine strengths. It explores the positive functions of shame and guilt, describes the conscious and subconscious defense mechanisms against them, and highlights the crucial family behaviors that initiate and encourage shame and guilt. Shame, Guilt, and Alcoholism thoroughly explains the significant differences between shame and guilt, including:

• clients'experiences of failure
• primary responses and feelings
• precipitating events and involvement of self
• origins and central fearsShame, Guilt, and Alcoholism adds immeasurably to our understanding of the total recovery process. It is an essential resource for therapists, social workers, psychologists, substance-abuse counselors, and educators in the field.

Chapter 1

Overview: Shame, Guilt, and Alcoholism

Introduction and Definitions

This volume was originally published in 1989. Now, over a decade later, a great number of studies have added immensely to the literature about shame and guilt, which are now identified as two of the “self-conscious emotions” (Tangney and Fischer, 1995) that also include embarrassment and pride. In particular, the concept of guilt has been reworked to emphasize its prosocial derivation from empathy and altruism and its adaptive, nonpathogenic aspects. True, guilt still serves the Freudian function of aggression control, but that effort now seems more positive, less the begrudging need to control one’s desires to avoid punishment and more a positive wish not to cause harm to those who are loved. Meanwhile, the details of shame have been investigated, with particular emphasis upon the connection between shame and rage. Also, there is increasing recognition that shame and guilt overlap tremendously, so much so that any particular event might evoke shame in one individual, guilt in another, and both affects in a third.

Still, the basic therapeutic equation remains the same with regard to shame and guilt. These affects are valuable both individually and socially in modest amounts—when they are experienced as temporary in duration, moderate in intensity, and point toward corrective action. A moderate amount of guilt leads toward reparation attempts, efforts to undo damage that the person feels responsible for, and to change one’s behavior so as to prevent further damage. Meanwhile, a little shame, even though it might feel terrible, motivates people to find better ways to fit in with others and even to do things that bring them pride. Problems occur, though, when individuals feel too much shame or guilt for too long a time or when they conclude that they cannot change their ways and so are doomed to a lifetime of perpetual failure. It is excessive, irredeemable shame or guilt that triggers escape efforts that in turn promote excessive use of alcohol or other mood-altering chemicals.

The therapeutic goal, then, with regard to these two affects, is to help clients develop a capacity to tolerate and utilize moderate experiences of shame and guilt while lessening experiences of overwhelming emotion. In effect, this means helping clients shed trait shame and guilt while better handling immediate, state shame and guilt.

My central goals in this book remain to help therapists understand how alcoholism and addiction is linked with shame and guilt and how they can best treat individuals who are chemically dependent, guilty, and ashamed.

Neither shame nor guilt have standard definitions in the literature. I offer the following definitions of these elusive terms: Shame is “a painful sense of one’s basic defectiveness as a human being,” while guilt is “uncomfortable self conscious affect related to the fear of harming others” (O’Connor, Berry, and Weiss, 1999, p. 186).

Shame and guilt are often confused by clients and therapists. The easiest way to distinguish between them is to remember that shame issues involve the client’s central identity, the global self. In contrast, guilt refers to negative judgment of the self because of specific actual or contemplated behaviors of the individual. The shamed individual laments “How could I have done that?” while the guilty party asks “How could I have done that?”

Table 1.1 provides a summary list of the important differences between shame and guilt. Although it is critical to distinguish between shame and guilt it is also true that many clients use these terms interchangeably. This may occur because some individuals simply do not have one or the other term (usually shame) in their vocabulary. Another reason, previously mentioned, is that shame and guilt overlap so that clients may experience both affects simultaneously or in rapid sequence. Fortunately, therapists seldom have to make hair-splitting distinctions between shame and guilt. Rather, they need to respond to both issues.

Table 1.1. Primary Characteristics of Shame and Guilt

Central Trait	Shame	Guilt
Failure	Of being	Of doing
Involvement of Self	Damage to global sense of self	Damage to active or moral sense of self
Action Tendency	To withdraw; to escape	To confess; to repair damage
Focus	On inadequate self	On impaired relationships
Sense of Self	Inadequate, deficient, defective, worthless, exposed, disgraced	Bad, selfish, evil, remorseful, irresponsible
Key Phrases	I am no good	I have done wrong
	I am not good enough	I have hurt someone
	I am unlovable	It is my fault
	I do not belong	I must make amends
	I should not be
Primary Response	Strong affective/physical response: eyes down, blush, shrinking, feel small, exposed	Strong cognitive and behavioral response: need to take action
Central Fear	Abandonment: not belonging (not getting in)	Punishment: ostracism (being cast out)
Primary Defenses	Withdrawal, denial, arrogance, exhibitionism, rage, perfectionism	Rationalization, selflessness, paranoia (projection)

Four Basic Distinctions Between Shame and Guilt

Shame and guilt, despite their similarities, are different experiences that vary in numerous ways. Contrasting the two states is valuable in understanding the significance of each.

The Experience of Failure

A sense of failure is a central characteristic of individuals who experience shame or guilt. The deficit is global for shamed persons—it is felt as a failure of being. Excessive shame experiences lead individuals toward feeling inadequate as human beings, as if, when born, God had made a mistake in creating such flawed and defective organisms. The shame crisis is spiritual in that shamed persons question the reason and meaning of their lives, often finding no justification for their existence. They believe they are less than fully human.

People experiencing shame sense they are falling far short of their goals in life. These expectations are not necessarily moral or ethical. They may be career, family, or even appearance oriented. They often reflect internalized parental expectations and introjects. Shame occurs whenever something happens that forces individuals to notice the gap between their actual or anticipated performance and those expectations. For example, a man who has grown up with “macho” beliefs may be humiliated by temporary impotence; one sexual disappointment implies to him that he is a sexual fraud. He may also believe that everyone can see his weakness and therefore they hold him in contempt.

Guilty persons deal with a different type of failure. Their interest is more externally focused in that their primary concern is with what they have done wrong and how their behavior affects others. Their error is one of doing rather than being. Instead of falling short, guilty individuals believe they have gone too far, violating a social norm or family rule. They then normally attempt to redress their transgressions by undoing whatever damage they have done and/or by accepting punishment for their misdeeds.

Primary Response/Feelings

Shame is a powerful physical event. Typically, shamed individuals respond throughout their body: one’s face may blush, eyes seem driven downward, the stomach churns, knees weaken. Victims may feel out of control of their bodies, which only exacerbates their shame. They feel visible, vulnerable, exposed, as if anyone can see right through them. They may literally or symbolically feel themselves shrinking in size, reduced towards nothingness. Their slightest flaws become magnified at these times; the tiniest spot on their tie or dress may loom gigantic. They may find themselves paralyzed by shame, unable to take a step, although they may desperately want to flee.

The words shamed persons are likely to hear themselves saying during these episodes are curses: “I am worthless,” “I am disgusting,” “I am dirt,” “I am nobody,” “I am nothing.” They notice no redeeming qualities about themselves.

The shame experience is a double blow. Individuals are devastated because they are so contemptible and because their defectiveness is so visible to others. They face an overwhelming sense of inadequacy, humiliation, and self-contempt.

Guilt is seldom perceived as a total body response. One person might report an upset stomach, another chest heaviness, while others do not notice any particular bodily reaction. Thus, it is not quite correct to state that someone feels guilt in the same way they feel shame. Guilt “feelings” are more cognitive than visceral, a collection of painful thoughts in which the pain is not strictly physical. Even so, guilty persons may suffer tremendously and their discomfort can feel as intolerable as that of shame.

Guilty people also call themselves names. Some of them are “I am bad,” “I am evil,” or “I am sinful.” Their minds fill with thoughts about what they have done, whom they have harmed, and what they must do to make amends. While these thoughts normally direct people’s attention towards taking corrective action, sometimes they become mired in obsession and self-punitive cognition. Then they get stuck in a state in which they cannot quit thinking about their misdeeds.

Action Tendency

Perhaps the most potent difference between shame and guilt rests in their “action tendencies,” the immediate cognitive and physical reaction that follows an experience of shame or guilt. The action tendency of shame is to withdraw, hide, or escape (Tangney, 1995), while that of guilt is an outward movement aimed at reparation of wrongdoing (Barrett, 1995). This outward movement leads to confession and apology (Tangney, 1995), as well as toward making direct efforts to undo any damage one has done.

This difference has many implications in the social sphere. One is that strong shame responses lead people away from others whereas strong guilt responses drive them toward others. Shamed persons tend to retreat from shame producing situations in an effort to preserve their injured self-esteem and even their identity while guilt laden persons move toward others in order to re...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Table of Contents
• Acknowledgments
• Chapter 1. Overview: Shame, Guilt, and Alcoholism
• Chapter 2. Models of Shame and Addiction
• Chapter 3. Shame, Vulnerability, and the Four Spheres of Self
• Chapter 4. Defenses Against Shame
• Chapter 5. Guidelines for the Treatment of Shame
• Chapter 6. The Treatment of Shame with Alcoholic Clients
• Chapter 7. Adaptive and Maladaptive Guilt As Related to Addiction
• Chapter 8. The Treatment of Guilt—General Considerations
• Chapter 9. The Treatment of Guilt with Alcoholic or Addicted Clients
• Chapter 10. Common Shame and Guilt Themes in Families Affected by Alcoholism or Addiction
• Chapter 11. Alcoholics Anonymous, Shame, and Guilt
• Chapter 12. Creative Approaches to Shame and Guilt: Helping the Adult Child of an Alcoholic
• References
• Index