Recently, in the ensuing stress associated with a 70+ work week, I decided to meet up with my long-time therapist (even therapists need therapists). As I began describing my internship experiences, she gave me a cursory overview of addiction counseling’s history. In my last post, (link above) I make the following comment:
Defined as “process by which a therapist provides direct, reality-oriented feedback to a client regarding the client’s own thoughts, feelings or behavior” (White & Miller, 2007, p. 2), therapeutic confrontation has a long history in the field of addiction counseling. Historically, this counseling style was utilized in chemical dependency treatment to overcome denial & resistance (Policin, 2003). Aggressive confrontational styles like “Synanon’s attack therapy” Pokin, (2003), were utilized to break down the defense mechanisms underlying an addict’s utilized to deny their problems. White & MIller (2007) described this confrontation as a highly varied form of confrontation ranging from “frank feedback to profanity-laden indictments, screamed denunciations of character, challenges and ultimatums. (p. 2)”.
Honestly, as described above, I’m really troubled by an approach like this. Rather than encouraging change through personal growth and increased insight, it sounds very shame-inducing. Admittedly, there are many aspects of addiction that are infuriating for addiction counselors. After all, Substance use disorders encompass a complexity of physiological, behavioral, and psychological symptoms. Physiological dependence is a byproduct of alterations in brain function due to prolonged exposure to an addictive substance, which produce strong cravings and withdrawal symptoms. Psychological components can include self-destructive patterns of behavior, poor self-control and ineffective coping skills. Treatment is rather complex as a result. In addition to addressing any long-term health issues, it is also essential to manage physiological symptoms of withdrawal. Addressing a client’s ambivalence to addiction treatment is complicated in light of these multifactorial issues and any lingering cognitive deficits.
So what is Coercion?
“The crux of coercion is to motivate the patient to comply with addiction treatment by enforcing consequences” (Sullivan, et al, 2008, p. 36). In examining the ethical nature of such practices, it is useful to consider the instances in which coercion is used throughout treatment. An obvious example of coercive treatment includes situations in which drug users are given a choice between treatment and penal sanctions for crimes committed (Stevens, 2012). Less obvious instances include staged interventions, contingency contracts, and pharmacological coercion via Antabuse (Sullivan, et al, 2008).
Ethical Considerations
There appears to be much controversy surrounding the issue of coercion in substance abuse treatments. Those who oppose coercive treatment techniques state that these interventions are a violation of an individual’s personal liberties, and right to informed consent (Sullivan, et al, 2008; Stevens, 2012). Advocates, however point out that “few chronic addicts will enter or remain in treatment without some external motivation, or legal coercion” (Sullivan, et al, 2008, p. 42). At first glance, I find legitimacy in both perspectives.
Proponents of Coercive Interventions
On the one hand, it is clear that long-term use of addictive substances can produce cognitive deficits that interfere with one’s ability to participate in the treatment planning process. This fact alone seems to support the notion that some coercive efforts may be called for, (including the less obvious forms discussed earlier). Some proponents stress that it is a duty to act on behalf of those who are impaired to make treatment decisions (Marlowe, et al, 1996). From this perspective it is presumed that “once treated the individual will be grateful in retrospect for the intervention” (Marlowe, et al, 1996, p. 77).
Critics of Coercive Techniques
In addition to violating an individual rights, critics counter by stressing the fact that treatment is often ineffective if the individual is unmotivated to change. The Transtheoretical Stages of Change Model, is in fact a great illustration of this and provides a useful perspective that allows us to assess a client’s level of ambivalence to change. Instead, helping the client increase their level of motivation to change is preferred (Sullivan, 2008).
Cultural Considerations
One resource provided an interesting discussion of cultural considerations pertaining to the use of coercive techniques that is also relevant. Collectivism and individualism each provide different perspectives of one’s “self” in relation to others, that is likely to determine effectiveness of such techniques. Individualistic societies promote the idea of self-responsibility, independence, and autonomy (Sullivan, 2008). As a result, from this perspective the individual is perceived to be responsible for their addiction, and coercive techniques are often less effective. On the other hand, collectivist societies provide a different view of the “self” as part of something greater. Individual well-being is a societal concern and coercive techniques are often much more effective. However, “collectivist families can also impede recovery if the group perceives drinking or drugging behavior as normal or an indication of weak character” (Sullivan, 2008, p. 44).
Conclusions.
Regarding the utility of coercive techniques, Marlowe, et al, (1996) notes that many of the less obvious forms of coercion, often involve forms of negative reinforcement. In fact throughout the treatment process are coercive influences that involve an “escape or avoidance reinforcement schedule…[in which] the aversive stimulus precedes the target event” (Marlowe, et al, 1996). With this in mind, Marlowe, et al, (1996) suggest that a comprehensive assessment of coercive influences may assist treatment planning. In fact, when reading this resource I’m reminded very much of behavioral therapy. The use of naturally occurring contingencies that influence one’s behaviors and decisions is common throughout treatment. If utilized in this way, I’m not against the coercive influence of a contingency contract, or staged intervention, as described by Sullivan, et al. (2008). However, I’m very “wet behind the ears”, and my thoughts on the matter are likely to change as time progresses….
References
Marlowe, D. B., Kirby, K. C., Bonieskie, L. M., Glass, D. J., Dodds, L. D., Husband, S. D., & Festinger, D. S. (1996). Assessment of coercive and noncoercive pressures to enter drug abuse treatment. Drug and Alcohol Dependence, 42(2), 77-84.
Polcin, D. L. (2003). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. SUBSTANCE USE & MISUSE, 38(2), 165-184.
Stevens, A. (2012). The ethics and effectiveness of coerced treatment of people who usedrugs. Human rights and drugs, 2(1) 7-16.
Sullivan, M. A., Birkmayer, F., Boyarsky, B. K., Frances, R. J., Fromson, J. A., Galanter, M., & Tamerin, J. S. (2008). Uses of coercion in addiction treatment: clinical aspects. American Journal on Addictions, 17(1), 36-47.
White, W. & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12-30.
As a student therapist, I am spending about 20+ hours a week at a substance abuse treatment center. The biggest lessons I’ve learned thus far, pertains to the nature of resistant as it appears within addiction. Since understanding this concept is critical to my effectiveness, I’m stopping to reflect upon what I’ve learned thus far….
From The Client’s Perspective…..
Last week at my internship site I was leading a therapy group for individuals struggling with addiction. At one point, during the session, someone asked me “what do you think of all of us?” This followed an exercise on awareness that required participants talked a bit about the consequences of their addiction. With the spotlight faced squarely upon me, everyone awaited silently for my response. I knew what I wanted to say, but was nervous in my ability to communicate it effectively. Starting off with a desire to put myself in the client’s shoes, this is what I hoped to convey…
I wanted to acknowledge their overwhelming sense of shame about what they had done, & how this made forward motion difficult.
I tried to let them know I understood they were struggling without their coping tools. I was aware of the full-on rush of thoughts & feelings came with this…
I hoped to convey empathy for their traumatic histories as well as the daily struggles that made quitting so difficult…
A perplexing mix of empathy and gratitude filled my mind. While my heart went out to them, a need for radical acceptance, opposite action, and responsibility lay before them. My mind floated toward my own pathway of recovery & healing. I was grateful for the long road to toward this present moment. I’ve really come a long way.
Paradoxical Dualism – Subjectivity & Objectivity
As I see it, a perplexing dualism exists within the counselor’s mind while providing therapy. On the one hand, you have a Rogerian unconditional positive regard as an essential element in the therapeutic relationship. On the other hand, you have the sort of confrontational style found with addiction counseling’s history. Where is there a middle ground between these extremes? In today’s medically-based climate, objective analysis of presenting symptoms is emphasized. Adding to this is is the attitude of individualism prevalent in Westernized medicine. As an INFP, I gravitate toward empathy, understanding, & validation. As a biracial individual, multicultural sensitivity is a priority. Is the pendulum swinging away from these things as it pertains to the practice of therapy?
From clinical perspective resistance to recovery is as infuriating as it is perplexing. Effective solutions to escape the miseries of addiction are available What is preventing them from utilizing these tools?!?!
…So how can one begin to step outside the empathist’s hat, and begin to develop a discerning clinical judgment on the matter of this perplexing resistance, that allows you to prolong & magnify misery when healing solutions exist within one’s reach? My first answer to this question came in the form of insights from the “SASSI-3”
Measuring Resistance – SASSI3
“SASSI” stands for “Substance Abuse Subtle Screening Inventory”. It is utilized in intake evaluations at the inpatient substance abuse facility I’m interning at currently. This brief self-reporting instrument helps identify those who are likely to have a substance abuse problem (sassi.com, n.d.). Of relevance to this post, are a few “subtle scales” which don’t have a direct bearing on substance abuse behaviors, but are useful for making”inferences” (sassi.com, n.d). I describe a few interesting subtle scales below:
“OAT” Obvious Attributes
“OAT Scale scores measure the extent to which an individual endorses statements of personal limitation…low scorerers are likely to be reluctant to acknowledge personal shortcomings. (Miller, Renn & Lawzowski, 2001, p. 3)”. As I understand it, this score reflects characteristics of our temperament that can either function as strengths or areas of growth. Low scorers are more prone to deny their shortcomings. Miller, Renn, & Lazowski, (2001) suggest that “it is not useful to agree or disagree with clients’ self-appraisals” (p. 3).. When encountering individual’s with low OAT scores, it is important to avoid being too critical since this can cause clients to become defensive. Instead motivational interviewing is useful to build discrepancy and reduce resistance.
“SAT” Subtle Attributes
The SAT score is useful in identifying “characteristics of substance misuse that are not easily recognized as such (Miller, Renn & Lawzowski, 2001, p. 3).” The utility of this measure, is in its ability to help reveal information clients deny to themselves or become deluded about. In other words, it is a measure of an individual’s degree of self-deceptiveness regarding the consequences of one’s behavior. Miller, Renn, & Lazowski, (2001) note the “sincerely deluded” (p. 3) nature of an addict’s tendency to avoid acknowledging the consequences of continued use. So how does one begin discussing such subjects?
“There is no point in giving people messages that are too strong and too discrepant from their points of view. On the other hand, there is also no point giving a message unless it promotes positive change. Successful feedback depends on starting from a point that clients can accept and then increasing the breadth of their understanding.(Miller, Renn & Lawzowski, 2001, p. 4).”
“DEF” Defensiveness
“The primary purpose of the DEF scale is to identify defensive clients who are trying to conceal evidence of personal problems and limitations (Miller, Renn & Lawzowski, 2001, p. 3).” In other words, it assesses an individuals tendency to conceal of an personal or situational problems in their lives. This is ego-driven activity, reveals how they feel about themselves in relation to others. For example, low DEF scores indicate low self esteem & feelings of hopelessness about one’s situation. In contrast, elevated DEF scores indicate individuals are concealing their problems in order to “fake good” (Miller, Renn, Lazowski, 2001, p.4). Concealing problems in this way serves to protect people from something painful they wish to avoid dealing with.
So to conclude, the SASSI-3 characterizes resistance as a: (1) a refusal to acknowledge personal shortcomings, (2) a tendency to remain deluded about the consequences of one’s actions and (3) a general desire to conceal personal problems from oneself.
So How Do You Address this Resistance????
Earlier this week, in a supervisory meeting, the interns sat down to discuss the cases they were assigned. As the “newbie” of the group, I stepped back and listen throughout most of the session. At one point, an intriguing debate ensued between the supervisory therapist and an experienced intern who is close to graduation. From their discussion, I noted two divergent attitudes on the utility of confrontation and direction. Underying these divergent attitudes were two very different approaches to therapy. What follows are two different therapeutic approaches that appear as opposite ends on a continuum. What follows is a description of the two extremes along this continuum of variance in therapy approaches:
A Rogerian Nondirective Stance
Non-directive therapy, considers the client to be his/her own expert. In other words, the direction that therapy takes depends on a client’s own personal judgment and not the therapist’s. Rogers describes non-directive therapy as client-centered in the sense that they have a capacity for self-understanding and self-direction. It is a mirror opposite of authoritarian confrontation common in addiction counseling. This empathetic approach involves the establishment of “a collaborative partnership that respects the client’s capacity for and right to self-determination (Policin, 2003, p. 20)”
From this perspective a therapist’s job is unconditional positive regard and an acceptance of their feelings. It excludes a need to explain, challenge, or direct (Raskin, 1948). The client’s subjective stance, takes presidence over the therapist’s clinical judgment:
“the nondirective point-of-view on this issue is that to the extent that some other frame of reference than the client’s is introduced into the therapeutic situation, the therapy is not client-centered” (Raskin, 1948, p. 106).
Confrontation in Counseling…
Defined as “process by which a therapist provides direct, reality-oriented feedback to a client regarding the client’s own thoughts, feelings or behavior” (White & Miller, 2007, p. 2), therapeutic confrontation has a long history in the field of addiction counseling. Historically, this counseling style was utilized in chemical dependency treatment to overcome denial & resistance (Policin, 2003). Aggressive confrontational styles like “Synanon’s attack therapy” Pokin, (2003), were utilized to break down the defense mechanisms underlying an addict’s utilized to deny their problems. White & MIller (2007) described this confrontation as a highly varied form of confrontation ranging from “frank feedback to profanity-laden indictments, screamed denunciations of character, challenges and ultimatums. (p. 2)”. This description resonates with a story my own therapist told me of her own internship experience at a substance abuse treatment facility in the 70’s.
A Comparison of Non-direction & Confrontation
Understanding of the client?
According to White & Miller (2007) the prevalent view of addicts changed somewhere between the 1920’s – 1950’s from an individual who was struggling with side effects of medications to a “‘vicious’ addict who sought narcotics as a source of pleasure” (p. 4). Implicit in this confrontational perspective is a view of the client the cause of these problems. This perspective focuses on an addict’s “defective, psychopathic personality (White & Miller, 2007, p. 4)”. In contrast, a Rogerian non-directed approach, focuses on the client not as a cause of the problems, but as the solution to them. Finally, modern perspectives point toward alterations in brain function.
Understanding Cause?
A Confrontational Perspective holds the client as the cause of his/her problems and attributes their issues to a personal defect of some sort (White & Miller, 2007; Policin, 2003). In contrast, a modern view of addiction holds a medically based-perspective which dictates that addiction is a disease. The cause of addictive behavior are neurological alterations in the brains reward system. These alterations in the reward and control circuits of the brain (Inaba & Chen, 2014) are associated with addiction since they are responsible for encouraging us to engage in those behaviors that are beneficial for our survival. Our textbook calls this reward pathway the “go switch” (Inaba & Chen, 2014, p. 2.13), since it is the brain’s motivator and reinforces beneficial behaviors. In an addict’s brain, alterations can be found in this area. Personally, I believe an epigenetic & biopsychosocial perspective best describes the complex causal factors underlying addiction.
Understanding the solutions?
Underlying the confrontational stance common in counseling’s history, is the fact that – if left to their own devices – addicts would continue to engage in self-destructive behavior. “…addicts avoid dysphoric affective states, anxiety, and genuine intimacy by using substances and engaging in antisocial behaviors, such as manipulation of others for their own needs” (White & Miller, 2007, p. 5).” This observation, appears to underlie the extreme forms of confrontation described earlier.
In contrast, modern treatment approaches involve symptom management during detox alongside some form of therapy (inpatient,outpatient, group and/or individual). Motivational interviewing is useful in helping the client attain self-awareness. This can involve helping clients gain insight into their addiction while uncovering behavior patterns and attitudes underlying their habit. Personally, I haven’t seen a pure non-directive stance in the addiction counseling field. However, I believe an empathetic stance and collaborative approach are critical factors of successful counseling.
In the next section, I’d like to return to that internship supervisory meeting I mentioned earlier. Here’s an overview of the two sides of the debate I listened to on that day….
Can There Be a Middle Ground Between Extremes???
Side one – Sugar Coating Truth.
The intern in this conversation made a comment on the pointlessness of sugar-coating the truth & asked the supervisor what the point was if we never confronted them on anything. “Isn’t there a case in therapy when it is warranted to give our opinion on matters pertaining to the client’s well-being?” After all, “to sugarcoat the truth is to do a disservice for the person who is on the receiving end. You don’t do anyone favors by avoiding blunt truth (Nguyen, 2015).”
Side Two – Raising Concerns on Confrontation & Coercion….
“It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate. (White & Miller, 2007).”
“Confrontation continues to play a strong role in many treatment programs (White & Miller, 2007, p. 176).” Obviously, it isn’t utilize in the extreme forms common in counseling’s history. However, despite its continued research has shown this method as often less effective than supportive approaches (White & Miller, 2007). Additionally Policin (2003) notes that confrontational styles, are shown to produce “harmful effects including increased drop-out, elevated and more rapid relapse, and higher DWI recidivism (p. 20).” My own impression of this approach is it has the potential to be harmful, shame-inducing. It focuses on change through emotional coercion over insight or conscious choice.
My thoughts thus far? Somewhere between these extremes lies a healthy balance.
References
Miller, F.G, Renn, W.R. & Lawzowski, L.E. (2001). Sassi Scales: Clinical Feedback. Springville, IN: The Sassi Institute.
Polcin, D. L. (2003). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. SUBSTANCE USE & MISUSE, 38(2), 165-184.
Raskin, N. J. (1948). The development of nondirective therapy. Journal of Consulting Psychology, 12(2), 92.
About three weeks ago I started the final segment of my educational journey: the internship. In a series of three classes I have to complete a minimum of 700 hours over the course of approximately ten months. This will require a 60+ hour work week for almost a year. I will continue to work full-time as a weekend night shift CNA in a float pool for large hospital system. I will be adding 20+ hours of unpaid work as an intern at an inpatient treatment facility for recovering addicts. As a wife and mother, this means I’m literally spending most of my waking hours in the service of others.
Keep in mind, a good majority of those I encounter will not appreciate my efforts, (and if they do, they don’t necessarily show it).
***Parenting a teen often involves being the bad guy as you set firm boundaries.
***Counseling individuals through recovery entails addressing varied levels of resistance.
***Working as a CNA requires you to provide care to individuals who often feel like crap.
I’m now in the third week of my first internship class and have finally settled into this new routine. I’ve tried to hold onto the glimmer of hope that graduation will come sooner than I expect. I continue to plan cautiously this new career path. I registered for that big “exam” required for licensure. I’ve researched other internship placements that can provide experience in populations outside the addiction community.
However, as I muscle through each week, I find my mental health slipping from my grasp.
As a new student therapist, I’m running several groups on my own…
I spend approximately ten hours a week teaching subjects to residents in an inpatient treatment facility that I have little knowledge of. Since the facility is redesigning the curriculum I’m told it’s my responsibility to come up with the subject materials myself. I enjoy this part, but the experience of standing in front of class each day brings me back to speech class in 8th grade where my childhood bullies taunted me merciless throughout a presentation. Despite my best efforts, my nerves always end up getting the better of me.
I conducted my first intake evaluations & individual sessions this week…
These experiences have had a perplexing effect upon me. While appreciative of the learning opportunity a burgeoning ignorance wells up within. As I learn more I feel I know less – if for no other reason than simply because I’m forced to face the breadth of my lack of knowledge. More importantly, book knowledge and interpersonal application are completely different things. I have one but must work on developing the other. I’ve come to an awareness that I really give to others based on who I am.
***All my efforts thus far have held a unique flavor that is very “Kathleen-like”.
***My life history and personality quirks are found throughout all l do.
***My preferred coping mechanisms (i.e. isolation & withdrawal) are not allowed.
***I must face my fears & allow others to see me fully – if I wish to succeed…
In this (& future) posts I’ve decided to share the material I’ve created for my therapy groups…
The subject matter often leaves me with much to reflect on personally. What follows is material I put together on blame, guilt, remorse & shame: concepts that all have potential to interfere with our efforts to creat lasting change. If handled correctly they can also provide an impetus for a personal transformation. Since this is a personal blog, I’m not sharing this information to educate or give advice. I’m presenting it as information relevant to my life story personally….
Understanding Guilt…
Defined as a feeling if responsibility or remorse for some offense, or wrong-doing it’s important to examine carefully how you handle it. The following quote comes from a blog post I found online on the subject of guilt, shame, remorse, and recovery:
“Oftentimes addicts in recovery need a great deal of time before they can even begin to understand that they are not inherently defective, that it was their choices and not their true selves that caused their addiction & its related negative consequences. (recoveryranch.com, 2013)”
As this quote indicates, a monkey-wrench in the recovery process is a misinterpretation of guilt. Interestingly, when replacing a few words, this quote applies to me as well:
“[when healing from trauma], a great deal of time [is needed]before [I] can even begin to understand that [I am] not inherently defective, that it was [my] choices and not [my] true [self] that caused [the] … negative consequences. (recoveryranch.com, 2013)”
With this parallel clearly drawn, further contemplation is now in order: How is it I’ve managed to turn guilt into something else so self-destructive, (i.e. Resentment, Shame, or Blame)????
Interestingly, guilt is not necessarily a bad thing (by itself). It hast the potential to provide an impetus for lasting change. Remorse – a characteristic of healthy guilt – encourages us to looking at past actions in order to understand their consequences. This information has predictive value for our current decisions: If I do “A”, then “B” is the result. The key is in learning how to use guilt for purposes of growth.
What follows are insights on how to use guilt as an impetus for change.
Use your remorse to take a personal inventory of your life.
Share your feelings of guilt & remorse with others (i.e. blog 🙂 )
Examine the origins of your guilt, Is it rational or reasonable?
Learn to forgive yourself & all involved.
Avoid the blame, shame and/or resentment traps (See below).
Change the behaviors that caused you to feel the guilt in the first place.
Apologize where necessary & let go for the sake of inner peace.
Commit to living in the present & moving forward.
guilt can also become healthy when misused:
As stated earlier, guilt can provide us with an understanding of how specific actions result in certain consequences. This information, however can be misused when we focus on attributing responsibility for punitive purposes. This punitive nature, causes us to focus on emotion instead of action. We live in the past, rather than act in the present. We are often blinded by a desire to complain about our problems. Guilt becomes blame when we assign responsibility to others for the “bad thing that happened”. In time, this blame can produce feelings of resentment. Shame, in contrast, is the attribution of responsibility to oneself. In time, they can produce feelings of resentment towards oneself.
when guilt becomes blame….
Blame usually involves assigning someone responsibility for the bad things that happened to you. Synonyms of blame include to condemn or accuse. However justified we might be, it is worth noting that blame is often counterproductive. In the short term, it allows us to escape elements of the truth which are often too painful to examine closely. However, the price we pay in the long term is a huge well of unresolved hurt that pollutes all life decisions. Blaming others has polluted my life with a crap-load of unresolved bullshit. This tendency to blame misery on externalized factors has caused a lifetime of willful blindness us to even the simplest solutions.
There’s more than a grain of truth to the saying that we perpetuate what we deny. So how did I overcome the blame that blinded me???
Step One – Identify your blame-laden complaints.
Listen to the words coming out of your mouth. Start a blog and note the underlying patterns in the ways you tell your life story. Or, if you don’t like writing, get an old digital camera and tape yourself, let the thoughts and feelings flow. Set it aside for about a week or so, and view this video when you’re mind is clearer. You’ll be surprised by what you say. When you notice a blame-laden complaints that involve a sad victim-story, write them down. Here’s a convenient example from a recent post in which I describe a minor misunderstanding between my sister and I that blew completely out of proportion….
Think like Joe Friday says: “Just the facts ma’am”. In other words, try restating your blame-laden complaining. How might you objectively describe your concern? The following example is a convenient neutral concern that takes any blame-laden language out of the above complaint. It also includes a link to a post titled “Transactional Analysis… A Move Beyond Misunderstanding”, where I provide 20/20 hindsight into the “Anatomy of a Misunderstanding” post. As I understand it now, this misunderstanding reflected larger issues pertaining to unmet needs in my childhood.
When you think about it, blame takes the focus off of you, and places it squarely upon others. You can’t see effective solutions because you’re not looking at what actions you can take to create change. Playing victim is good for the ego, but highly self-destructive. Accepting responsibility and seeing the situation in full and complete detail has taken time as it pertains to the above examples. My relationship with my sister has improved with time, and has required much work on my own part…..
Resentment is a bitter and angry indignation over unfair treatment or perceived wrongs. It is the emotional cousin to blame-laden thinking. Blame is a thought process that involves the attribution responsibility for our situation to the action of others. Resentment results when you ruminate over this realization endlessly. When you focus on it too much the anger can build and you can’t see further. All you know is you hurt and they need to understand and pay. Trust me when I tell you, resentment can eat you alive and leave you with nothing else.
It is for this reason that I believe that forgiveness is essential for healing, it is necessary in order to make room for the good stuff.
When Guilt Becomes Shame….
As I mentioned earlier, guilt can be impetus for lasting change. It has the potential to provide valuable and empowering insight. However, when this insight is used to assign responsibilty for punitive purposes, it becomes highly self-destructive. Blame is the attribution of guilt to external factors (i.e. people, events, situations). It causes resentment. In contrast, shame is the attribution of guilt to yourself with a punitive belief that “we are flawed and therefore unworthy of acceptance or belonging.” (Brown, 2010, p4).
Shame is being rejected.
Shame is feeling like an outsider.
Shame is that part of yourself you hide.
Shame is not belonging
Shame vs. Guilt….
Shame tells us we are bad. It is a useless emotion we are all susceptible to. Guilt tells us we have done something wrong and indicates a need for reparation?
Shame = I am bad. It is about the person.
Guilt = I have done something bad. It is a reaction to a person’s actions.
Shame vs. Humiliation…
Humiliation results from a situation of unequal power in which we are made to feel inferior or ashamed. Shame is a private matter. Humiliation is a public event.
Shame = Is a byproduct of internalizing messages from others.
Humiliation = is caused by messages from others which causes us to feel degraded.
Moving Beyond Shame….
Step One – Examining Our Shame Webs.
Shame is the consequence of our interactions with others – and society in general. These interactions carry implicit messages of who we should be to in order to garner acceptance and belonging. For the most part, these messages exist as unresolved expectations. The are a filter through which life experiences are examined and resolved. With this in mind, there are several critical questions to ask yourself:
What messages of perceived-worth underlie your feelings of shame?
Can you describe these wanted and unwanted identities?
Where do these messages of shame come from?
Step Two – Understanding the Consequences of Shame.
Shame is about fear of disconnection (Brene, 2010). This fear of being ridiculed, diminished or ostracized can cause us to actively avoid situations that we associated with it. However, by avoiding situations that make us feel shame, we end up re-living old messages from others about what and/or whom we should be. Others from long ago in our past, tell us who we should be in the present whether we realize it or not. The end result is a hamster-wheel life in which you can create no more of the same thing…
Step Three – Define Your Shame Triggers….
Individuals, who are highly resilient to shame, understand their shame triggers (Brene, 2010). These triggers reflect early messages of shame from our childhood. For example, standing in front of my group therapy class produces heightened anxiety. I recognize this as a byproduct of the implicit messages from peers in my speech class in 8th grade. I feel shame and embarrassment, and want the attention focused away from me. By acknowledging this, I am aware these emotions reflect past memories, and not the current situation. With this in mind, ask yourself the following questions:
How would you like for the world to see you?
How would you hate for others to see you?
How do these aspects of your self-image reflect messages you receive from others?
Shame & Belief Systems….
Shame is based on a system of belief about who we are in relation to others. This belief-system consists of a collectivity of messages about who we are. As belief system, the underlying concepts are matters of opinion and not fact. Beliefs are opinions about how the world works & our place in it. When we share these ideas with others, they become systems of belief. When taken on blind faith they appear to function as objective truth. In reality, they are simply shared systems of meaning that we support collectively as self-fulfilling prophecies with social consequences for violation. The key to overcoming a system of belief based on messages associated with feelings of shame is in differentiating between facts and opinions….
You can change beliefs with facts but you cannot change facts with beliefs. In other words, beliefs require a believer while facts exist independent of them.
For example, lets say you’re boiling noodles in a large dutch oven. When they’re done you drain the noodles in a strainer. The water goes down the drain and what remains are noodles. Life functions like a strainer, it is the perfect reality filter. Bullshit doesn’t hold water, and goes down the drain. The noodles remaining are facts and/or consequences that go nowhere until you deal with them. They are here to stay. KNOW THE DIFFERENCE!!!
References…
recoveryranch.com (2013, December, 9). The ‘recovery value’ of shame, guilt and remorse (part one). [blog post] Retrieved from: https://www.recoveryranch.com/articles/early-recovery/the-recovery-value-of-guilt-shame-and-remorse-part-one/
Brown, B. (2015). Shame Resilience Theory: A grounded theory study on women and shame. Families in Society. 87(1), 43-48.
