Shame, Pride and Psychotherapy

with Children and Adults

Ken Benau, Ph.D.
Ann Martin Center
May 18, 2012
Why are shame and pride important to psychotherapy?
Shame is important because:

 Shame negatively impacts one’s 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.
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 what’s possible (experientially); helps maintain

motivation throughout “tough times” of therapy (“dark nights of the soul”).

• Therapy is not merely about alleviating the patient’s shame, but also enhancing their
genuine pride.
 

Phenomenology of pathogenic shame, self-righting shame, hubristic pride, and authentic pride

Model of optimal arousal:

 
Hyperarousal
______________________________________
 
Window of optimal arousal
 
_______________________________________

Hypoarousal
 
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 one’s
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 other’s 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 shamer’s attack or dismissive behavior, and
redirect it toward the true self experience (i.e. thoughts, feelings and behavior).
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 thud—splat. 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.
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 one’s 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 one’s whole being, not merely one’s ill-considered actions.

To paraphrase a patient of mine , “I didn’t live up to what I know I am capable of, and how I want to be with
others. I don’t feel crushed or like I don’t 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)
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 one’s

accomplishments, while remaining relational (i.e. empathic toward
and accepting of others).
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 one’s own achievements… self-respect (Dictionary.com).
 
 A sense of one’s own proper dignity or value. The most successful or thriving
condition (Answers.com).
 
 Consciousness of one’s own dignity (Oxford Dictionary online).
 
 Delight or elation arising from some act, possession or relationship (Merriam-Webster).
 
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).
Phenomenology of pathogenic shame, self-righting shame,
hubristic pride, authentic pride

Authentic (non-hubristic) pride, following word origin:

 Being “pro” or “for” one’s “being” or “essence”.

 Taking pleasure in oneself, or “joy in being” and in one’s 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.

 Pride’s 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 easily—that is, their essence or
being, is liberated.
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.
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)

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”
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 clear—in theory. We feel
guilty for what we do. We feel shame for what we are.”
Lewis B. Smedes, Shame and Grace
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.

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
Developmental theories of shame
Traditional theory: Age 2 ½ 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.
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.
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.
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 person’s 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.
Shame and its manifestations in children and families

Internalizing forms

 Inhibition: Fear of trying new things; clinging: “Reassure me that I’m not
bad”, while at the same time not being able to accept the reassurance
because they feel they must be bad.

 Social anxiety: “They’ll make fun of me”; “They won’t like me and I’ll have
no friends”.

 Social isolation: Withdrawal

 Perfectionism: Child can’t reveal or admit mistakes or vulnerability.

 Depression: Including shutdown, withdrawal, indecision (associated with

the neuropsychology of shame, where speech centers “shut off” and person
can’t “think straight”.
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.
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 child’s
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, Asperger’s, social anxiety.

Social abilities with family: e.g. separation from parents , going to school, age-
appropriate independence.
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 (can’t think or feel) child
collapses into pathogenic shame.
 
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.
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)
 
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
Shame and its manifestations in adults
Interpersonal functioning

Marital, family, work-related. E.g. keep distance, hide

true self don’t trust and are not trusted by others,
which further exacerbates problems.

Grandiose, dismissive, arrogant defenses against shame,

expressed toward colleagues, spouse, children, etc.
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.
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 don’t try to convince me otherwise.

Patient rejects or dismisses all praise, with remarks like, “You have to say
that, you’re 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 I’m not”. This can be
understand as a discrepancy between the patient’s conceptual/neo-cortical
parts of the brain, and the “participatory” or “procedural knowing”, or
“limbic” and arousal system.
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 haven’t addressed shame directly, in the here and now, and in the
relationship (Bromberg, p. 154, STH).
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.
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).
Working with shame and pride in therapy:
Adults

Video demonstration and discussion: “Jake”

 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