Shame and pride serve many intrapersonal and interpersonal functions, and understanding how best to work with each in psychotherapy, particularly with survivors of relational trauma (see Schore, 2001), is essential. This is part of a series of posts that have been culled from my past psychotherapy practice. All patients described have graciously given me permission to describe our work together, and all case descriptions are highly disguised to protect patient confidentiality while still educating the reader about the importance of shame or pride in psychotherapy. 

In this series on “Shame and Pride in Psychotherapy with Relational Trauma”, three functions of shame or pride are explored. These include how: 1) Care sought and unmet is shaming; 2) Shame is both an attachment “problem” and “solution”; and 3) Therapist spontaneity and the element of surprise embodies adaptive, “pro-being pride” in therapist and patient alike.

References

Schore, A. N. (2001). The effects of relational trauma on right brain development, affect regulation, and infant mental health.  Infant Mental Health Journal, 22, 201–269.

“Care sought and unmet is shaming”

To seek special care and love when we are hurting and to have those needs met, is to know, without words, that we are both loved and “good”. To repeatedly not have our desire for care met, particularly when we are most vulnerable, is deeply shaming. This was brought home again, to me, in a session with an early relational trauma survivor whom I’ll call “Fran”.

Vignette

“Fran” grew up with an anxious father who often needed Fran to comfort and reassure him that he was a good-enough father, and with a mother who was more emotionally absent or anxiously preoccupied. 

Fran was triggered when her boyfriend, visiting from out of town, decided to stay for less time than Fran had anticipated and hoped. This left Fran feeling unloved (even though she knew her boyfriend loved her), frightened (that she would be desperately alone), enraged (that her boyfriend didn’t make more of an effort to stay longer), worried (that her anger would push her boyfriend further away) and ashamed (that she was so “needy”).

Fran requested an extra therapy session with me that week, in order to help her better manage her triggered response so that she did not act out with her boyfriend.  At the start of our session, Fran expressed fear that asking for additional time with me— in her words seeking my care and love— would make her somehow “wrong”. She wanted me to reassure her that I was okay with her asking for additional time. I reminded Fran I had already told her on the phone, when she requested the extra session, that I understood she was having a harder time this week and that if she thought it might be helpful that we could have an additional session.

Still, a part of Fran feared that I would withdraw from her for seeking more of my care, just as she had experienced repeatedly with her father. Fran also observed a knot in the center of her back, and following an approach I learned from Sensorimotor Psychotherapy (Ogden & Fisher, 2015; Ogden et al, 2006), I invited her to focus on the knot and notice how her contracted muscles wanted her to move. Fran did, her shoulders curling in, chest becoming concave and her hands covering her eyes. Asked what this posture said, Fran remarked, “I can’t let your love in because you’ll leave me, again”. 

In retrospect, it is interesting that Fran’s movements reflected the classic shame posture. Further, it is worth giving considerable thought to the relationship between “shame” and the belief, “You will leave me because I am unlovable or unworthy of your love.” There is much evidence to suggest that shame is one response to abandonment fear or terror, and also an understandable response to being or feeling excluded by a loved other, be that “other” an individual, family, social group, or society.

Back to our session: Fran next felt a wave of deep sadness and despair, feeling hopeless that her needs could be met. This left her feeling like she was collapsing inside. While I first suggested Fran imagine her adult self, me and a circle of loved ones tending to this young sad part, as we’d done successfully before, Fran didn’t embrace this suggestion, I believe, now, because she was too much in the grips of a young, collapsed state that wanted me to “fix her” (Fran’s words). 

I then thought Fran needed to have more energy available to her adult self and a greater sense of connection with me, before we could attend to the very young part of her that felt so bereft. I suggested Fran and I both stand and that we find a distance between us that felt right to her. She found just the right distance (about 4 feet apart), and then spontaneously picked up two pillows and cradled them like a mother with her infant child. 

After doing that for a short while, Fran placed one hand on top of the stacked pillows and one on the bottom, and asked if I would do the same, which I did. After some time, I decided to lift my hands off the pillow so that Fran could sense my remaining energetically in connection with her symbolic younger self, without physically contacting the pillows.  Fran liked this exercise, which we repeated several times.

Since I knew Fran had said she feared our session would end and a young part of her would feel “all alone again”, I decided to play with her experience of connection and disconnection. I suggested Fran take the pillows with her and move about the room, or even outside the room, to see if her younger self could still feel cared for by her adult self and me. She did, but quickly became anxious that she was somehow “wrong”, as though I had sent her away because her needs were too much. Notice, again, the eruption of shame in response to anticipated separation and abandonment.

When Fran returned with the pillows and asked me to place my hands on them again, she said, speaking to her pillows/younger self, “There’s nothing you need to do” (i.e. to be cared for and loved).  I reinforced that by repeating those words, and then said as I pulled my hands away from the pillow, “Nothing you did was wrong.” We repeated this action several times before our session ended. That is, Fran’s hands and mine on the pillows, first my and then our together speaking to Fran’s imagined younger self: “There’s nothing you need to do”, and my hands off while her hands remained holding the pillows: “Nothing you did was wrong”. This enabled Fran to feel re-vitalized and playful as she turned the pillows into cymbals that she “played” as she moved about the room on her own, and I gave her plenty of room to do so. Fran left the session feeling less collapsed, less ashamed, and more hopeful.

Final Reflections

Through shared movement and words, Fran and I played with her very young belief that seeking care, followed by separation/distance meant there was something shamefully wrong with her, as she felt with her father, especially, as a little girl. Together we helped Fran recognize that: 1) she could reconnect with her more resourced, adult self while remaining in connection with me (e.g. our standing together); 2) she could feel my emotional support and presence even when I wasn’t symbolically holding her younger self (via the pillows); and 3) she could simply receive her own and my care (“There’s nothing you need to do”), and that separation did not mean she was shamefully “wrong” for wanting or needing my care (“You did nothing wrong”).

I hope this post demonstrates how “care sought and unmet” is often experienced as shaming, particularly in survivors of relational trauma and chronic, emotional mis- or non-attunement. Likewise, I hope this vignette makes clear that deeply understanding this important source of shame can be healing, both intra-relationally (patient with patient) and inter-relationally (therapist with patient).

References

Ogden, P. & Fisher, J. (2015).  Sensorimotor Psychotherapy: Interventions for Trauma and Attachment.  New York: Norton. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: Norton.

Ken Benau, PhD, is a licensed clinical psychologist with 27 years’ experience. He has a private practice in psychotherapy, consultation and training in Kensington, CA, located in the San Francisco Bay area.
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