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Ken Benau, Ph.D. Ann Martin Center May 18, 2012 Slide 2 Why are shame and pride important to psychotherapy? Shame is important because : Shame negatively impacts ones 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. Slide 3 Why 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 whats possible (experientially); helps maintain motivation throughout tough times of therapy (dark nights of the soul). Therapy is not merely about alleviating the patients shame, but also enhancing their genuine pride. Slide 4 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Model of optimal arousal: Hyperarousal ______________________________________ Window of optimal arousal _______________________________________ Hypoarousal Slide 5 Phenomenology 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 ones 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 others 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; and Squelch any anger that might protest or challenge the shamers attack or dismissive behavior, and redirect it toward the true self experience (i.e. thoughts, feelings and behavior). Slide 6 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Pathogenic shame follows the Wiley Coyote 4-step model of arousal: Step 1: Shock The 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: Drop A 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 Proper A 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 thudsplat. For some, the shame experience is either repeated or unrelenting, which is both overwhelming and unbearable. Step 4: Dissociation What 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. Slide 7 Phenomenology 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 ones 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 ones whole being, not merely ones ill-considered actions. To paraphrase a patient of mine, I didnt live up to what I know I am capable of, and how I want to be with others. I dont feel crushed or like I dont 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 ) Slide 8 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride Well-regulated pride, also known as authentic, genuine or non- hubristic pride In the upper end of arousal. Allows the person to take pleasure in oneself and ones accomplishments, while remaining relational (i.e. empathic toward and accepting of others). Slide 9 Phenomenology 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 ones own achievements self-respect (Dictionary.com). A sense of ones own proper dignity or value. The most successful or thriving condition (Answers.com). Consciousness of ones own dignity (Oxford Dictionary online). Delight or elation arising from some act, possession or relationship (Merriam-Webster). Slide 10 Phenomenology 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). Slide 11 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic pride Authentic (non-hubristic) pride, following word origin: Being pro or for ones being or essence. Taking pleasure in oneself, or joy in being and in ones 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. Prides 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 easilythat is, their essence or being, is liberated. Slide 12 Phenomenology of pathogenic shame, self-righting shame, hubristic pride, authentic pride Dysregulated, 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. Slide 13 Phenomenology 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) Slide 14 Further 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 Slide 15 Differentiating 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 clearin theory. We feel guilty for what we do. We feel shame for what we are. Lewis B. Smedes, Shame and Grace Slide 16 Clinical 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 shame or guilt and reparative action. Slide 17 Transforming pathogenic shame into self-righting shame or guilt Turning toward Intra-relational, followed by inter-relational repair Dyadic regulation, followed by inter-relational repair Psychoeducation Mindfulness Slide 18 Developmental theories of shame Traditional theory: Age 2 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. Slide 19 Developmental 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. 55-84. Slide 20 Developmental 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. 55-84. Slide 21 Developmental theories of shame Still-face paradigm (Tronick) and its relevance to the earliest precursors in the development of shame and pride Clinical relevance of the theory of development that situates shame and pride at the preverbal level Reminds us to pay attention to the shame that results when a persons 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. Slide 22 Shame and its manifestations in children and families Internalizing forms Inhibition: Fear of trying new things; clinging: Reassure me that Im not bad, while at the same time not being able to accept the reassurance because they feel they must be bad. Social anxiety: Theyll make fun of me; They wont like me and Ill have no friends. Social isolation: Withdrawal Perfectionism: Child cant reveal or admit mistakes or vulnerability. Depression: Including shutdown, withdrawal, indecision (associated with the neuropsychology of shame, where speech centers shut off and person cant think straight. Slide 23 Shame and its manifestations in children and families Externalizing forms Acting 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. Slide 24 Shame and its manifestations in children and families Content of shame Everything 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 childs 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, Aspergers, social anxiety. Social abilities with family: e.g. separation from parents, going to school, age-appropriate independence. Slide 25 Attachment style and its relationship to shame in children Insecure attachment Anxious 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 (cant think or feel) child collapses into pathogenic shame. Slide 26 Shame 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. Slide 27 Shame and its manifestations in adults Internalizing forms Inhibition, anxiety, social anxiety, social phobias. (Shamed self avoids social contact, and then further shames self for social difficulties). Depression Psychosis Substance abuse, alcoholism (primary/causative and secondary/effects) Slide 28 Shame and its manifestations in adults Externalizing forms Shaming others: e.g. Narcissistic Personality Disorder Aggressive acting out Bipolar: dysregulated sense of self (worthless/grandiose) Over-activity: distract self from painful emotions, especially shame Slide 29 Shame and its manifestations in adults Interpersonal functioning Marital, family, work-related. E.g. keep distance, hide true self dont trust and are not trusted by others, which further exacerbates problems. Grandiose, dismissive, arrogant defenses against shame, expressed toward colleagues, spouse, children, etc. Slide 30 Shame and its manifestations in adults Gender and shame Men: 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. Slide 31 Shame 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 dont try to convince me otherwise. Patient rejects or dismisses all praise, with remarks like, You have to say that, youre 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 Im not. This can be understand as a discrepancy between the patients conceptual/neo-cortical parts of the brain, and the participatory or procedural knowing, or limbic and arousal system. Slide 32 Shame 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 havent addressed shame directly, in the here and now, and in the relationship (Bromberg, p. 154, STH). Slide 33 Working with shame and pride in therapy: Children Psychoeducation and social skills instruction Parts 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. Slide 34 Working with shame and pride in therapy: Adults Sensorimotor psychotherapy (SP) Mindfulness and Parts work Moving between the inter-personal and intra-personal experience of shame: Using portrayals with part-self experience AEDP (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). Slide 35 Video demonstration and discussion: Jake Working with shame and pride in therapy: Adults Slide 36 Contact Information Ken Benau, Ph.D. 376 Colusa Avenue, Suite #2 Kensington, CA. 94707 (510) 525-3702 For information about joining my blog: Shame, Pride and Psychotherapy kbenau@comcast.net