BCACC Blog

by Stacy Jensen, M.Ed, RCC

 

In my clinical practice I see a thread of chronic shame woven throughout the fabric of life of many of my male, or male identifying clients; a thread just waiting to be plucked that sets in motion a degree of dysregulation and personal pain that will be avoided at nearly all costs. The difficulty is that this thread is most often initiated in their most intimate relationships— those of deep love, that are most precious, including their relationship with those tender, routinely disavowed wants and needs within themselves.

Many definitions of shame/chronic shame exist, and those which ring most true for me attempt to describe with heart the wholesale dysregulation, destruction, and attack on the very core of the person that shame elicits. Patricia DeYoung (2015) defines chronic shame as “one’s felt sense of self disintegrating in relation to a dysregulating other” (p. 18) and Dorahy (2015) includes the desire to hide, disappear or even die. For those who experience chronic shame, these descriptions begin to describe what it feels like psychologically and neurophysiologically when activated.

Shame vs. Chronic Shame

It’s important to differentiate between shame and chronic shame. Chronic shame appears much earlier than shame; first seen in the 2^nd year of life, prior to conscious memory, remaining in a wordless state (Hill, 2015). The dysregulation experienced by the child is “”affectively burnt in” the infant’s developing right brain” (Schore, 2014, p.390), becoming a thread that is waiting to be picked, touching “a wound made from the inside by an unseen hand” (Kaufman, 1989, p.5), that reverberates throughout one’s interpersonal life. Additional research by Schore (2017) shows that male children are at increased risk for a number of psychopathologies because of slower brain maturation, particularly on the right brain, which leaves them vulnerable longer to negative experiences, particularly relational trauma that form the fabric of shame.

For those with chronic shame, integrated strategies for avoiding and surviving shame (Hill, 2015) are woven into the client’s Internal Working Model (Bowlby, 1973) – the way that people see themselves, the world, and their place in it. If we add to this Daniel Siegel’s (2010) assertion that ‘the brain is an anticipation machine’, we can see why chronic shame states are so incredibly enduring, and that no matter how safe or stable things are in the present, the thread of chronic shame remains active, and when activated, the same neural affective states that were experienced as a child are re-experienced by the adult client. We must remember that because chronic shame is formed prior to declarative memory, it exists outside of the conscious memory system, leaving it largely impervious to cognitive therapies, rendering clients baffled by the repetition of these intensely dysregulating interactions.

The benefit of bringing shame more into our clinical awareness, is that it can shift our focus from simply attending to behavioural issues and patterns—addictions, disengagement, anger, perfection, procrastination, pleasing—and begin to see the role that chronic shame, which is often dissociated from the client’s awareness, is having on initiating or perpetuating these patterns, and focus not just on the fire, but the fuel that is feeding it.

Common Expressions of Chronic Shame

Clinically, I see two common expressions of chronic shame that are often used unconsciously and interchangeably by the client. The first is to internalize the shame and implode or collapse in on themselves, feeling the full weight of the humiliation or mortification embedded in the affective states of their nervous system and psyche. The second is to externalize and attack the interpersonal other, feeling the grandiosity and righteousness of their actions in defense of the disintegrating self (shame reaction). Chefetz (2016) includes contempt, dissmell, and disgust within the shame spectrum of emotion, and I see this play out both internally and externally within each pattern. Needless to say, the severity and intractability of chronic shame creates massive turmoil and strain within their most intimate interpersonal relationships.

Research and my clinical experience suggest that what is needed for clients to work through chronic shame is for them to experience solid, stable, caring relationships, including the therapeutic relationship, where they can feel the pluck of the dysregulating shame and share it with another person, have it witnessed, and, against all expectations in their emotional being, have them not be judged or criticized, but witnessed and cared for. This deeply relational process, both within, and outside of therapy, creates opportunities for corrective emotional experiences that begin to unwind the chronic shame, both cognitively for the client, as they begin to develop a fuller relationship with this process that resides in them, and within their neurophysiology. Donald Kalsched (2013) sums this process best: “what has been broken relationally must be repaired relationally. This calls for affectively focused treatment” (p. 13, Italics in original). Processing chronic shame is long term work, and requires nuance and care to weave between the disintegrating, near automatic responses of the shame state, and the need to provide an attuned, caring presence: Over time “the therapist provides an emotional re-education and remediates a developmental void” (Maroda, 2009, p.20). Additionally, it is critical that the intense affect be modulated so that dissociation can be limited and the client can maintain connection to their adult witness within the present moment, as the healing of trauma can only happen in the here and now.

It is my hope that as clinicians, we can attune to this debilitating dynamic in our clients that is often overlooked or misinterpreted, but is actually hiding in plain sight.

 

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Stacy Adam Jensen, M.Ed. works from an affect regulation, somatic and attachment orientation in his clinical and teaching practice. He specializes in working with chronic shame and relational trauma. He lives, works and plays on Coast Salish land in Victoria, BC. www.stacyadamjensen.com

 

References:

Bowlby, J. (1973). Attachment and Loss, Vol. 2: Separation, Anxiety, and Anger. London: Penguin Books.

Chefetz, R. Catastrophic Shame and the Reorganization of Self, retrieved online Nov 4, 2018- http://csar.nyc/catastrophic-shame-and-the-reorganization-of-self/

DeYoung, P. (2015). Understanding and treating chronic shame: A relational/neurobiological approach. New York: Routledge.

Dorahy, M. (2015). Shame and Dissociation in Complex Trauma Disorders Webinar.

Hill, D. (2015). Affect regulation theory: A clinical model. New York: Norton.

Kalsched, D. (2013). Trauma and the Soul: A psycho-spiritual approach to human development and its interruption. New York: Routledge.

Kaufman, G. (1989). The psychology of shame: theory and treatment of shame-based syndromes- 2^nd edition. New York: Springer.

Maroda, K. (2009). Less is more: An argument for the judicious use of self-disclosure. In Bloomgarden, A. and Mennuti, R. B., (Eds.) Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy. New York: Routledge, p. 17 – 30.

Schore, A. (2014). The right brain dominant in psychotherapy. Psychotherapy. 51 (3): p. 388-397.

Schore, A. (2017). All our sons: The developmental neurobiology and neuroendocrinology of boys at risk. Infant Mental Health Journal. 38(1): p.15-52

Siegel, D. (2010). Mindsight: The New Science of Personal Transformation. New York. Bantam.

by Su Russell, M.Ed., RCC

 

Recently, I decided to retire from my work as a Registered Clinical Counsellor. I began the process of reducing my practice by referring clients on to other practitioners. At 76 years of age I had, in the natural order of things, accumulated a number of clients who were older women.

I soon discovered that those clients were having difficulty finding the support they needed, as many older female therapists in Victoria had either retired or had a full practice. Seeing an older counsellor was very important to them; they were unanimous in feeling that the counsellor’s age would enhance the ability to honour the client’s years of life experience and to empathise with the challenges they faced.

As a result of these shared sentiments, I began to reflect on how my work had served this population of clients and, more importantly, to notice how that work varied from the time spent in sessions with clients ten to thirty years younger. As a result of these reflections I realised that I wanted to continue my practice, but to shift my focus to work with clients over 60 years of age.

The Journey

Our North American culture does not honor the elderly. Little of social consequence is offered to support the exploration of the deeper fears and reflections which preoccupy the aging as they look at the latter third of their lives. Resources are often limited to superficial entertainment, spiritually bland volunteerism and organised group exercise or activities.

Erik Erikson’s stages of development, as described in Childhood and Society (1950) identifies a series of stages that an individual should pass through from infancy to late adulthood to achieve a healthy psychosocial outcome. In his work, Erikson described introspection as the existential conflict of the eighth and final developmental stage. He described the years beyond sixty-five as the time when a personal review of one’s life and accomplishments take place. Erikson noted that the outcome of this review could be a perspective full of integrity, or one fraught with despair. The result depended on one’s personal sense of achievement and satisfaction over a lifetime.

The more favourable outcome of the two conflicting forces of the eighth stage of psychosocial crisis – integrity- is often illusive. In this context, integrity is not defined in the usual way, but, as Erikson described it “the acceptance of one’s one and only life cycle as something that had to be” (Erikson, 1950, p 268) or “a sense of coherence and wholeness”(Erikson, 1982, p 65). Success in this stage leads to the wisdom to look back on life with a sense of closure and to accept death with grace.

The journey however is not a smooth one; frequently, there is a desperate attempt to hold the alternative, despair, at bay. Wisdom is not a solid state. It is transient and fickle, particularly to the aging. At times, self-doubt, fear and confusion mar its reputation; it is a continuous process of re-evaluation and searching for answers, often propelling the client into despair.

As we age, we face the challenges of retirement and the resulting financial adjustments. We are further distressed by health, beauty and body changes. We experience relationship shifts with partners, family and friends. We suffer the loss of parents and family members through illness and through death. The invisibility that accompanies aging in our culture is rampant and instances of being ignored or patronised commonly occur, often daily. Being called “dear” by someone of the age of one’s own child is humiliating at best, and an insult at worst. Frequent offers of help can carry with them the insinuation that, on some level, we are not able to manage physically or mentally, magnifying the fear that this will some day likely be a fact. Grief becomes a frequent reality, summoned by losses on all levels, not just the physical.

There is a recurrent need – no, urge, for the client to attain clarity about their person and place in their present day lives. Paramount is the search for connecting with their authentic self. Building a sense of community around what matters most to them becomes essential. A life of “spirit”, self defined, becomes more and more important, as regular connections with people and significant activities are less and less a part of their lives.

Members of this gender and age grew into young women in the tumultuous years of the fifties and sixties. Raised by mothers who were restricted by outdated ideals at a time when women’s roles were beginning to undergo radical changes, they have spent a lifetime attempting to define their identity and sense of purpose. They have had few older female models as guides and consequently may be left with a tenuous sense of self.

Frequently, experience and wisdom are words used to describe the years beyond sixty. While it may be that we have achieved sometimes great things in the past and developed valuable insights to share with those who are younger, our personal experience in the present moment is feeling neither wise nor experienced. Often the life skills we have acquired seem to have no meaning in the present circumstances.

Aging is a day to day task of accepting the inevitability of our future. Loneliness and apprehension about what lie ahead dominate our thoughts. Sharing these, often despairing, feelings with others who have similar concerns and who are willing to listen is frequently a challenge. Inevitably, the repair of historical and developmental trauma will surface, but that which surfaces most frequently at this juncture, is a need to make peace with the present, and to move toward a more deeply satisfying way of living into the immediate future. The journey consists of examining everything we know and have experienced to create a new context for living the remaining years of our life.

Shared Conversations

As we age, I have noted that support systems thin out, often due to limited capacity, isolation, decline, and illness. While individual support, when available from a counsellor, is critical at critical times, I have also become acutely aware of the need for meaningful community for aging clients.

Women express enthusiasm for groups with other women, where they can talk openly about the lived experiences which define their present-day perspectives. Clients are explicit in stating that they do not want to do group process work, but that the groups be small, intimate gatherings focused on conversation. Mentored by a respected elder capable of creating a safe space where sensitive and sometimes painful present-day stories can be shared, is important. Airing reflections on current experiences of coping take place; women muse that humour is not an uncommon resource! They express excitement about reviewing film, literature and media material relevant to the group and creative activity is encouraged. There is an interest in expanding on themes related to the spiritual aspect of aging.

Questions generating a shared conversation might include:

What, at this moment in your life, carries the most meaning for you?

How will (that) significant experience influence how you approach the next year of your life?

What do you notice is your richest connection at this period in your life?

Clients express the desire, the urgent need, for a place to reflect and express their ideas and perspectives frankly and honestly. They are also willing, in fact enthusiastic, about sharing the experience of their journey with other older women.

 

Final Thoughts

My clients’ challenge is no longer work around their past, but conspicuously about being present to the experience of aging. They do not require motivation to do this work. They are driven to do it by the mere awareness of their mortality. They want to create a meaningful and integrous perspective as they age by reframing the awareness and knowledge gained from years of life experience to suit this new, and final, stage of their lives. They want to navigate the journey in community with others, and in refreshing, fruitful and peaceful ways.

 

References:

Childhood and Society. Erik H. Erikson. New York: Norton, 1950.

The Life Cycle Completed. Erik H. Erikson. New York: Norton, 1982.

 

Birdwings

Your grief for what you’ve lost lifts a mirror

up to where you’re bravely working.

Expecting the worst, you look, and instead,

here’s the joyful face you’ve been wanting to see.

Your hand opens and closes and opens and closes.

If it were always a fist or always stretched open,

you would be paralyzed.

Your deepest presence is in every small contracting and expanding,

the two as beautifully balanced and coordinated

as birdwings.

– Rumi

The Essential Rumi as translated by Coleman Barks, 1995

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Su Russell BA, MEd (counselling) has a private practice in Victoria focused on a client population of women over 60 years of age. She looks forward to participating in mentoring individual and group conversations which will enhance the lived experience of aging for her clients. For more information on www.surussell.com

 

In the Spring 2018 issue of Insights magazine, Avraham Cohen, PhD, RCC, CCC, and Heesoon Bai, PhD, RCC are interviewed for the Member Profile. The following excerpt is from the original interview and is a supplement to the article in Insights. Read more in INSIGHTS.

 

Insights: Do you see shifts and changes in client issues? Have people always had many of the same problems or are there trends?

Avraham: From my five decades of professional experience, I have come to see the core issues that individuals and couples present to me to be perennial, even though how issues are presented in their languaging and nuances, their emphasis and social relevance, may have changed over time. I have also seen many “new” modalities of treatment come and go, but they all try to address the same core issues and attempt to alleviate suffering.

This is how I explain the core issues: basically, individual human beings are subjected, from birth onward, to the societal programming in mainstream culture (norms) that strongly suggests — nay, defines — what constitutes a good, successful, and meaningful self and life. Under such pervasive pressure to conform to norms — and to face withdrawal of love and support for not conforming — people end up getting disconnected and dis-integrated from their “minds,” “hearts,” “bodies,” “souls,” and “spirits.” When this happens, they then begin to chase after the externalized ideals of what an individual or couples’ life should be like.

This often translates into unquestioned beliefs like: “There is a perfect person out there,” “If only I could just get it right, I would be happy like those other people,” “The world is a place of scarcity, and I have to compete for survival,” and so on. According to this programming, if you are not having a successful life, you just are not trying hard enough, and you only have yourself to blame. Or else, in defiant self-defense, you may practice other-blame: your children, your spouses, your boss, your government, and endless others.

Putting this in a more metaphoric way, most of us are born bright and shiny, and this is consistent from the inside to the outside. Over time and persistent subjection to the influences of the world, the shininess begins to be covered and the psyche-soma changes shape and some hard structures are produced that protect the shiny core. As we grow up, these hard structures become our personality, and most of us do not question that this is who we are. However, it is not!

As Schellenbaum describes eloquently in his book, The Wound of the Unloved (1988),* we have become who we are not, in the service of getting what little love that’s available; we settle for the scraps and not the full-bodied essence of love, as this is all we know, at least until something happens in life to show us a different view.

Heesoon: I agree: core issues that confront humans have not changed. I will point to the 2,500-year-old Four Noble Truths of the Buddha’s teaching that has been gaining a solid recognition amongst counsellors as “truths” about human existential conditions. I will also point to the prevalent and still mounting interest in practices like “mindfulness” and “self-compassion” as an indication of recognizing the core and perennial human existential issues.

Avraham: In my professional and personal life, I am witness to an enormous amount of experience that suffering people describe. Overtime, I have developed a psychological perspective and ways of making sense of all these materials presented to me. For us, most all these descriptions are signs of a problem, not the problem itself — an indication of the underlying early bonding and related security/personal comfort issues that proliferate and lead to the formation of personality structures that have been constructed for survival, protection, and getting along in the world.

Since these structures are seamlessly tied together with patterns of thinking, emotion, sensation, and energy, they are very powerfully locked into place, automatic, and unconscious. They run our lives, and we behave as though “we can’t help it.”

For me, the only substantive question for a therapist is: how do we awaken enough to effect change to the harmful and damaging programs that are running our lives and the lives of our clients? I see counselling and psychotherapy as the pursuit of a personal enlightenment.

Avraham and Heesoon will be presenting a “Presence and Relationship Workshop”  June 22 – 23, 2018 in Vancouver. The workshop explores the intrinsically related processes of presence and relationship within the context of  personal history and contemporary culture. 

 

*Schellenbaum, P. (1990). The wound of the unloved: Releasing the life energy (T. Nevill, Trans.). Dorset, GB: Element Books. (Original work published 1988).

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Many of Avraham’s writings can be found at http://summit.sfu.ca/collection/204. To reach him directly, email: [email protected].

Heesoon is currently co-editing a volume on ecological virtues (University of Regina Press). Many of her academic publications can be downloaded at http://summit.sfu.ca/collection/204. To reach her directly, email: [email protected].