Shame Treatment & Management

Kansas City Psychotherapy Counseling Services – Treating Shame

The Developmental Impact & Long-Term Effects of Shame

Presented by Jeff Peterson, LCPC, LPC, NCC

This educational workshop is focused on helping mental health clinicians understand the dynamics of shame within a variety of client populations, particularly Lesbian, Gay, Bisexual, Transgender, & Questioning (LGBTQ).  This includes identifying those at greater risk, examining attempts to reduce shame via adaptive/maladaptive responses, exploring how shame works via the compass/cycle of shame, and discussing the connection between trauma, judgment, self-worth, and shame.  Together we will discuss best practices and what social workers & healthcare providers can do to help their clients mitigate the harmful effects of shame.

Download a PDF of Short Presentation:  The Developmental Impact and Long-Term Effects of Shame – Jeff Peterson.pdf

Download a PDF of Long Presentation:  Shame Presentation – PetersonJeff.pdf

Objectives of this Presentation:

  1. Differentiate between shame and guilt

  1. Explore the ways shame manifests through cultural messaging and microaggressions

  1. Examine how individuals attempt to reduce or avoid shame

  1. Introduce the Compass of Shame Model for understanding the developmental trajectory of shame

  1. Investigate how some individuals turn against themselves as an attempt to regain efficacy

  1. Identify those who are most at-risk

  1. Discuss what providers can do to help clients process and overcome the long-term effects of shame

  1. Share current best practices for shame management and shame reduction

Facts About Shame & Guilt

•Guilt is tied to behavior, shame is globalized

•Healing guilt involves forgiveness, Healing shame involves acceptance

•Shame generally results in passivity, guilt often stimulates activity

•Shame is highly correlated with addiction, depression, violence, bullying, suicide…. Guilt is inversely correlated with those things

•Guilt usually invokes confession, Shame generally leads to hiding/concealment

•Shame can be defined as a form of self-trauma, a loss of faith in one’s self that results in hypervigilant self-monitoring

•Internalized shame is a loss of faith in one’s self, reinforced by our self, not just society.  We become our own self-saboteur, we are our own worst enemy, our own constant bully.

•Shame is often contextualized by our social connections (via attachment) and exacerbated by philosophies that promote singularity rather than plurality.

Key Points Regarding Shame & LGBT Identities

•Homophobia is internalized before we have a sense of who we are.

•Hiding parts of ourselves produces shames and affects our relationships with other.

•Depression, anxiety, relationship issues, overachievement may all be signs of internalized homophobia.

•So much of shame is dealing with the expectations of others.

•As children, we may not hear anything derogatory about LGBT people, but do we hear anything at all? It’s as if LGBT people do not exist.

•For some, identifying as LGBT is too much to bear so treatment may be avoided. If that’s the case, consider working on other areas of the client’s life, like trauma, before discussing the LGBT issue.

•The power to identify with the tribe (or group) is strong. This may inhibit someone from coming out or cause an individual who does not fit the definition of “LGBT” to be shut out from the community.

•Strategies include identifying and naming internalized homophobia: some clients may not be aware of the dynamic.

  1. Remember to move at your loved one’s pace: they may not be ready to identify as LGBT.

Resources Addressing Shame

Clinical Resources

Ronda Dearing & June Price Tangney – Shame in the Therapy Hour

Sue Johnson – Emotionally Focused Therapy for Couples

Alan Shore – Affect Regulation and the Origin of the Self

Laurence Heller – Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship

Del Rosario, P.,  White, R.  (2006). The Internalized Shame Scale: Temporal stability, internal consistency, and principal components analysis, Personality and Individual Differences, 41(1), 95-103.
Woien, S., Ernst, H., Patock-Peckham, J., Nagoshi, C. (2003).  Validation of the TOSCA to measure shame and guilt. Personality and Individual Differences, 35(2), 313-326.

Andrews B, Qian M, Valentine JD. (2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology. 41(1), 29-42.
Hook A, Andrews B. (2005). The relationship of non-disclosure in therapy to shame and depression. British Journal of Clinical Psychology. 44(3), 425-38.

Wong, M.R., Cook, D. (2006).  Shame and its contribution to PTSD. Journal of Traumatic Stress. 5(4), 557-562.
Wiechelt, S., Sales, E. (2001) The role of shame in women’s recovery from alcoholism: The impact of childhood sexual abuse. Journal of Social Work Practice in the Addictions, 1(4), 101-116.

Bybee, J., Sullivan, E., Zielonka, E., Moes, E.  (2009).  Are gay men in worse mental health than heterosexual men? the role of age, shame and guilt, and coming-out.  Journal of Adult Development, 16:(1), 144–154

Gausel, N., Leach, C.  (2011). Concern for self‐image and social image in the management of moral failure: Rethinking shame, European Journal of Social Psychology, 41, 468– 478.

Dwairy, M.  (2010).  Parental Acceptance–Rejection: a Fourth Cross-Cultural Research on Parenting and Psychological Adjustment of Children.  Journal of Child & Family Studies, 19(1), 30-35.

Greene, D., Britton, P.  (2013).  The influence of forgiveness on Lesbian, Gay, Bisexual, Transgender, and Questioning individuals’ shame and self-esteem.  Journal of Counseling & Development, 91(1), 195-205.

London, B., Downey, G., Bonica, C., Paltin, I.  (2007).  Social causes and consequences of rejection sensitivity.  Journal of Research on Adolescence, 17(3), 481-506.

McDermott, E., Roen, K., Scourfield, J.  (2008).  Avoiding shame: young LGBT people, homophobia and self-destructive behaviours.  Journal of Culture, Health and Sexuality, 10(8): 815–829.

Videos for Clients

TED Talk: Brene Brown – Listening to Shame

http://www.ted.com/talks/brene_brown_listening_to_shame?language=en

The Whittington Family – Ryland’s Story

https://www.youtube.com/watch?v=yAHCqnux2fk

TED Talk: Brene Brown on vulnerability

http://www.ted.com/talks/brene_brown_on_vulnerability

John Bradshaw – Healing the Shame That Binds You

https://www.youtube.com/watch?v=5q2tZa1gp8Q

Books for Clients

Christopher Germer – The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions

Byron Brown – Soul without Shame: A Guide to Liberating Yourself from the Judge Within

Alan Downs – The velvet rage: Overcoming the pain of growing up gay in a straight mans world, Second edition

Brene Brown – Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent and lead, also see I Thought it Was Just Me, and The Gifts of Imperfection

Dossie Easton & Janet W. Hardy – The ethical slut

Gershen Kaufman – Shame: The Power of Caring

Francis Broucek – Shame and the Self

Ronald Potter-Effron – Letting Go of Shame

John Bradshaw – Healing the Shame That Binds You

Donald Nathanson – Shame & Pride

Jane Middleton-Moz – Shame & Guilt

Ann Weiser Cornell – The Power of Focusing: A Practical Guide to Emotional Self-Healing

Terrence Real – I Don’t Want to Talk About It

Bibliography & Clinical References From Jeff’s Presentation

Bash, H., Papa, A.  (2014).  Shame and PTSD Symptoms.  Psychological Trauma: Theory, Research, Practice and Policy, 6(20), 159-166.

Bybee, J., Sullivan, E., Zielonka, E., Moes, E.  (2009).  Are gay men in worse mental health than heterosexual men? the role of age, shame and guilt, and coming-out.  Journal of Adult Development, 16:(1), 144–154

Carbone, D.  (2008).  Treatment of gay men for post-traumatic stress disorder resulting from social ostracism and ridicule: Cognitive Behavior Therapy and Eye Movement Desensitization and Reprocessing approaches.  Archives of Sexual Behavior, 37(1), 305-316.

Centers for Disease Control and Prevention (CDC). (2011).  Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 — Youth Risk Behavior Surveillance, Selected Sites, United States, 2001–2009. MMWR Early Release, 60, 1-135.

Dearing, Ronda L. (Ed.); Tangney, June Price (Ed.).  (2011).  Shame in the Therapy Hour.  Washington, DC: American Psychological Association.

Dwairy, M.  (2010).  Parental Acceptance–Rejection: a Fourth Cross-Cultural Research on Parenting and Psychological Adjustment of Children.  Journal of Child & Family Studies, 19(1), 30-35.

Gausel, N., Leach, C.  (2011). Concern for self‐image and social image in the management of moral failure: Rethinking shame, European Journal of Social Psychology, 41, 468– 478.

Gilliland, R., South, M., Carpenter, B., Hardy, S.  (2011).  The roles of shame and guilt in hypersexual behavior.  Sexual Addiction and Compulsivity, 18(1), 12-29.

Goldsmith, S., Pellmar, T., Kleinman, A., Bunney, W.  (2002).  Medicine’s Reducing Suicide: A National Imperative.  Washington, DC: The National Academies Press.

Greene, D., Britton, P.  (2013).  The influence of forgiveness on Lesbian, Gay, Bisexual, Transgender, and Questioning individuals’ shame and self-esteem.  Journal of Counseling & Development, 91(1), 195-205.

Harman, R., Lee, D.  (2010).  The role of shame and self-critical thinking in the development and maintenance of current threat in PTSD.  Clinical Psychology and Psychotherapy, 17(1), 13-24.

Hatzenbuehler, M.  (2011).  The social environment and suicide attempts in Lesbian, Gay, and Bisexual Youth.  Pediatrics, 127, 896–903.

Hernandez, V., Mendoza, C.  (2011).  Shame resilience: A strategy for empowering women in treatment for substance abuse.  Journal of Social Work Practice in the Addictions, 11(1), 375-393.

Iwen, M.  (2015).  Shame, Sexual Addiction, and Consumption in American Culture.  Sexuality and Culture, 19(1), 413-425.

Jimenez, X., McAfee, S.  (2010).  Crystal Methamphetamine, Body Dysmorphia, and Shame: A Psychodynamic Case Report from the Trainee Perspective.  Journal of Gay & Lesbian Mental Health, 14:355–366.

London, B., Downey, G., Bonica, C., Paltin, I.  (2007).  Social causes and consequences of rejection sensitivity.  Journal of Research on Adolescence, 17(3), 481-506.

Luoma, J., Kohlenberg, B., Hayes, S., Fletcher, L.  (2012).  Slow and steady wins the race: A randomized clinical trial of Acceptance and Commitment Therapy targeting shame in substance use disorders.  Journal of Consulting and Clinical Psychology, 80(1), 43-53.

Marshal, M., Dietz, L., Friedman, M., Stall, R., Smith, H., McGinley, J., Thoma, B., Murray, P., D’Augelli, A., Brent, D.  (Aug 2011).  Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. Journal of Adolescent Health, 49(2), 115-123.

McDermott, E., Roen, K., Scourfield, J.  (2008).  Avoiding shame: young LGBT people, homophobia and self-destructive behaviours.  Journal of Culture, Health and Sexuality, 10(8): 815–829.

Mereish, E., Poteat, V.  (2015).  A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health.  Journal of Counseling Psychology, 62(3), 425-437.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

Oktedalen, T., Hagtvet, K., Hoffart, A., Langkaas, T., Smucker, M.  (2014).  The trauma related shame inventory: Measuring trauma-related shame among patients with PTSD.  Journal of psychopathological Behavioral Assessment, 36(1), 600-615.

Peden, M., McGe, K, Krug, E.  (2002).  Injury: A leading cause of the global burden of disease.  Geneva: World Health Organization.

Ploderl, M., Faistauer, G., Fartacek, R.  (2010).  The Contribution of School to the Feeling of Acceptance and the Risk of Suicide Attempts among Austrian Gay and Bisexual Males.  Journal of Homosexuality, 57(7), 819-841.

Rizvi, S., Brown, M., Bohus, M., Linehan, M.  (2011).  The role of shame in the development and treatment of BPD.  In Shame in the Therapy Hour, Daring, R., Tangey, J.  (eds).  Washington, DC: APA.

Ryan, C., Huebner, D.,  Diaz, R., Sanchez, J.  (2009).  Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults. Pediatrics 2009;123:346–352.

Sherry, A.  (2007).  Internalized homophobia and adult attachment: Implications for clinical practice.  Psychotherapy: Theory, Research, Practice, Training, 44(2), 219-225.

Suicide Prevention Resource Center. (2008). Suicide risk and prevention for lesbian, gay, bisexual, and transgender youth. Newton, MA: Education Development Center, Inc.

Tan, P.  (2005).  The Importance of Spirituality Among Gay and Lesbian Individuals.  Journal of Homosexuality, 49(2), 135-144.

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