Understanding and Treating Chronic Shame

Healing Right Brain Relational Trauma

Patricia A. DeYoung

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000513042
• Edition: 2
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

A masterful synthesis of relational and attachment theory, neurobiology, and contemporary psychoanalysis, Understanding and Treating Chronic Shame has been internationally recognized as an essential text on shame. Integrating new theory about trauma, shame resilience, and self-compassion, this second edition further clarifies the relational, right-brain essence of being in and with the suffering of shame. New chapters carry theory further into praxis. In the time of a national Truth and Reconciliation Commission and a global Black Lives Matter movement, "Societies of Chronic Shame" invites therapists to deepen their awareness of collective societal trauma and of their own place within dissociated societal shame. "Three Faces of Shame" organizes the clinical wisdom of the book into clear guidelines for differential diagnosis and treatment. Lucid and compassionate, this book engages with the most profound challenges of clinical practice and touches into the depths of being human.

Part One

Understanding Chronic Shame

1 Ubiquitous and Elusive

The Problem of Chronic Shame

DOI: 10.4324/9780367814328-2

I am a relational psychotherapist. I help clients develop an emotional understanding of themselves within the whole context of their lives. I am client-centred and empathy-focused, so I don’t go through a checklist of symptoms with my clients in order to give them a diagnosis. Instead, I ask what the trouble is, and together we spend time with what hurts. Most clients talk readily about their problems with stress, anxiety, and depression. Often clients tell me about difficult relationships and share painful emotions. Sometimes they say, “I have trouble feeling good about myself.” But they rarely say that shame is a problem.¹

If they don’t bring shame into the conversation, I don’t either, because I know it can be deeply shaming for a client to admit to feeling shame. Yet without admitting it to themselves or to anyone else, clients may live with the pervasive effects of shame every day, especially those clients who have a history of relational trauma.

As a relational therapist, I believe that most symptoms of so-called mental illness have something to do with *childhood relational trauma. While I seek to understand my clients’ symptoms of distress in the context of their current lives and relationships, I also listen for what went wrong for them early on. I have ears for the quiet trauma hidden in stories of clients’ relationships with well-meaning but fragile, wounded parents. I also hear in accounts of cruel, abusive caregivers the story of relational trauma inflicted when a child’s best hope of loving attachment was crushed.²

Once hurt, human beings have remarkably creative ways to repel and avoid further harm, and so relational trauma engenders a wide spectrum of symptoms that both protect and constrict a vulnerable self. Most commonly, clients tell us about anxiety far stronger than their life situations warrant and about depression that drags them down even when everything seems to be going well. And then there’s that other ubiquitous symptom of relational trauma – chronic shame – which clients don’t usually mention, though they may speak of problems with self-confidence or self-esteem.

Many years of watching for the silent shame that shadows my clients’ lives have led me to believe that shame is a much more powerful and pervasive phenomenon than most of us realize. When I say that, I echo a small chorus of theorists who have been writing about shame and psychoanalytic psychotherapy for the last half century. In later chapters, I will visit this theory. I won’t have much to add about how chronic shame destroys emotional well-being or about what a terrible, lifelong affliction it can be. Rather, I will pick up many threads of theory about development, shame, and clinical practice and weave them into a new narrative about chronic shame that takes into account recent advances in affect regulation theory, interpersonal neurobiology, trauma theory, and relational psychoanalytic theory.

I believe that relational psychotherapists are well-positioned to help clients who struggle with the chronic shame that follows on early relational trauma. If it’s a core problem for them, we need to address it, always subliminally and often directly. It is indeed possible to work with chronic shame effectively, as illustrated in the second part of this book. But to do effective work with chronic shame, we first need to understand it well – the aim of the first part of the book.

Rather than begin with shame theory, however, I will begin with some stories from my own practice. The personalities and circumstances are fictionalized, but the essential situations are real, and so is the chronic shame at the heart of them. In their dissimilarity these stories illustrate the range and variety of disguises that chronic shame wears. They also reveal some important common themes that belong to the experience of chronic shame.

Producing a Stellar Performance

Recently, a client returned to me after several years away. I’ll call her Clare. I first saw her when she’d just lost an executive position. With a generous severance package, she’d set up a consulting firm of her own. But she couldn’t make herself do the work to keep her business running. She found herself spending days drifting to the kitchen and eating too much, evenings drinking too much, and nights sleeping badly.

Clare came to me because, as she put it, “I need somebody to kick my butt.” We found, instead, that she needed me to understand what being a vice president had meant to her, the sense of worth and power it had given her, and what it felt like to have all of that ripped away with no warning. She believed she should have seen it coming. She thought maybe she should have refused the package and fought back. “But nobody wins against company lawyers.”

As Clare came to realize that there was nothing she could have done, she began to feel the pain of her loss more acutely, and then she could accept the sadness and anger of a grief process. She was surprised to find that on the other side of grief she was less anxious and more able to organize her life productively. It seemed our work was done.

Clare returned four years later. Her consulting firm was now a partnership of two, and they were writing a book. She had also turned her hobby of buying, renovating, and selling houses into a second business. She felt competent and powerful again, but there was something wrong in her marriage. She was on the verge of having an affair. I suggested couple therapy with a colleague, and she saw me concurrently.

Clare had never spoken much about her husband, whom I’ll call Geoffrey. They had married in their late 30s and decided not to have children. They had interests in common – travelling, golf, building a cottage. She made him laugh, and he was like a rock for her, “a buttoned-down accountant, but a really good man.” In couple therapy, they learned that both of them had been feeling lonely and misunderstood by the other for quite a while.

In her own therapy, Clare worked hard to understand what was going on for her. She didn’t want to leave Geoff for Larry, she said, but it was so very tempting. Larry was a good time guy, life of the party, “A lot like me,” Clare said. He could match her energy in ways her safe husband never could. Clare wanted to break free, “to soar on unclipped wings.”

But as it turned out, when Clare pursued Larry a little harder, he played hard to get. To save her self-respect, she wrote him off. Meanwhile in the couple therapy, Clare and Geoff were talking to each other and feeling understood. As energy returned to her primary relationship, Clare’s restlessness and anxiety abated. Again it seemed our work was done.

But recently, after another five years away, Clare returned again. She had sold her business interests to younger partners to retire early. It was the pleasant retirement she and Geoff had planned, with time for weekends away and long trips abroad. However, once again Clare was miserable at home.

“I can’t believe I feel this bad,” Clare told me in her first session back.

Stuff from years ago is coming back to me. I think about losing the VP position, how that could have been different. If I’d just been smarter, I could have been a CEO. I think about Larry. That maybe I missed my chance for something really “me.” Who is this “me” with Geoff? I think about the money I’ve made – not much, really. Enough for this comfortable life, but nothing spectacular. I’m boring, and fat, and old, and I haven’t done what I thought – twenty, thirty years ago – I could do with my talent and energy. In fact, I am consumed, just consumed, by self-loathing every day. What’s wrong with me?

I decided to take a risk and say what I thought: “My best guess is that chronic shame is what’s wrong. It’s been under all the other work we’ve done over the years, but we could never actually see it. Now we can. What do you think?”

Clare was silent. Then she told me a story about golf. She had worked hard with the club pro all summer to take her handicap down. An out-of-town group came to play in September, and the pro contacted four other women – not Clare – to put together the two foursomes.

“I heard about it by accident,” she said. “And you know what? I couldn’t say to him, ‘Why not me?’ I couldn’t say it because I knew I would just bawl, and yeah, it was shame – that I was such a baby! At my age. But I didn’t play again last fall.”

Clare hated needing to matter like that. She hated that those things meant far too much – things like being a CEO, being desired by an exciting guy, making a pile of money, having a handicap of 9. Those were her ways to keep shame away. But they were never fail-safe; shame could always break through.

“So if it’s there, this chronic shame, where does it come from?” she asked. I sketched the story I know: a child has to have at least one caregiver who is able to respond in an attuned, consistent way to what the child feels. If this is missing in a major way, the child will translate the distress of the mismatch into a feeling like, “I can’t make happen what I need … so there’s something wrong with me.” Not necessarily in those words, I said; just a feeling in the bones, and more or less intense, depending on how bad the mismatch is and how long it continues.

Clare was quick to link my explanation to what she knew of her history: her mom was treated for depression after Clare’s birth. Clare was the third of three girls in four years, with a brother, the “beloved,” born three years later. Her mother wanted her girls to be pretty and quiet, but Clare was smart and loud. Despite her tough, funny exterior, she felt misunderstood throughout childhood and adolescence.

We talked briefly about how a depressed mother can’t be available when a child reaches out. We guessed that this miss happened often enough so that little Clare gave up on her mother. But of course, children can’t stop needing, so a complicated pattern developed: while shutting down her longing to be really seen and loved, Clare learned to get attention by being funny and smart at school, if “difficult” at home. Feeling good about competence and its rewards took on a life of its own and became Clare’s life.

“And I’ve done my therapy about this!” Clare said, looking me in the eye. I hadn’t been her first therapist, so I could only nod. “I know all about that neglected feeling from my childhood, and how I’ve been trying to get attention ever since. So what are we going to do about this problem?”

Good question, I thought. When in doubt, stay in the moment. So I said, “Tell me more about what it’s like to be you right now. There’s this self-loathing. I guess there are other feelings too?” She responded by talking about different parts of herself that felt different things.

Suddenly they became a cast of characters – a tough, funny person who can fake anything, a pleaser who cares too much, and a mean bitch who puts the pleaser down. “We’ll call her Lillian,” she said.

“Lillian?”

“My mother. I know it’s not my mother. Well, it is – but it’s me, too.” Clare began to explore what the pleaser part of her felt when Lillian was mean. With my encouragement, “Pleaser” started to tell Lillian about wanting and being angry and the shame of caring too much.

None of this history was new to Clare. But new energy was sparking and surging in the room. It was connected to a new sense of the problem: we had named the shame and given it narrative context both in the present and in the past. Perhaps most importantly, we were going after it not with logic, but with a kind of creative exploration that required each of us to be present to the other and engaged in the moment.

Leading a Double Life

Not everyone who suffers from chronic shame can rise above it with outstanding performances of a competent self. Shame takes hold in different ways, depending on children’s dispositions and on the many possible forms of mismatch between children’s needs for connection and caregivers’ abilities to respond. Some caregivers respond with a pattern of connection that’s more confusing than absence; in some moments they are intensely present, needing connection themselves, but often they are oblivious to the needs of the children in their care.

These children learn that if connection is going to keep happening, they need to match the cues coming from their parents. Their own spontaneous needs, which would generate their own cues, are muted or disappear. A connection like this is more twisted than broken, but it is just as likely to produce a lifetime of chronic shame. Played out across a lifespan, it will look more like accommodation to others than like self-sufficiency. Well-being ...