Elements of Shame Sensitivity
Shame competence training gives practitioners skills to understand and manage shame.
Shame is like syrup on our bodies,” says Valerie Gough, LMFT, a psychotherapist in private practice in Orange County, California. “It makes us feel like we are always in trouble,” even when we’re not the wrongdoer. It’s been described as “a frequent, often poorly recognized sequel to trauma, occurring as a result of the meaning the individual places on the traumatic experience and on subsequent interpersonal and environmental events.”1
Certain shame can be healthy. “There are situations where shame may be appropriate, for example, in the context of doing something dishonest or immoral like cheating on a test,” says Erika Morris, JD, MA, LMFT, a therapist in Los Angeles who specializes in working with members of the LGBTQ+ community and creatives, whether their art is visual, written, performative, or other forms of expression. But toxic shame is feeling bad about who you are at the core, a feeling that comes from externalized cues that become internalized. In the journal Personality and Social Psychology Review, Sana Sheikh says, “There can be cultural variations in how individuals present shame and react to it.”2
“Toxic shame is not something we are born with,” she adds. “It comes from the negative external messages and cues we’ve been exposed to that become applied to part of our identities.” That shame, Morris says, “may come from a religion, culture, or upbringing.”
Vulnerability to such shame may be due to individuals’ backgrounds and the messages they received about identity, belonging, and what—and who—is acceptable.
“In psychodynamic exploration, we will take a look at the forces that have shaped you, from childhood onward, that have informed how you see yourself now,” Morris explains. Shame may be a kind of subtext that has been experienced across a lifetime and about which one may not have been consciously aware.
The Shame Lens: Seeing How Shame Accompanies Trauma
“Shame is a core emotion for people who have experienced trauma,” Dolezal says. “It is central to the posttrauma state and clearly drives decision-making and behavior.” As such, there’s a need to elucidate the client’s experience through the shame lens. “People will do anything to avoid shame,” she adds. “It is a concrete barrier to getting help, an emotion of social power and social control.”
Shame is integral, and it is also taboo in societies at large. Because it seeps into every level of relationships, it affects the collective consciousness as well as an individual’s emotional state. “Utilizing a shame lens gives the professional a micro understanding of what the patient is likely experiencing in the moment.” This understanding helps create shame competence.
Defining Shame Competence
In health care or public sectors and in private companies, many services are intensely hierarchical and bureaucratic, Dolezal says. Time constraints, chains of command, and paperwork are some of the things that chip away at the well of emotional resources a clinical or public service worker must devote to the client. Practitioners can feel ashamed, and this emotion of shame can be pushed onto the client. This occurs on an unconscious level. Patients may sense this and believe they are a burden. While such systems are necessary, they inadvertently—and paradoxically—keep the patient at the bottom of the hierarchy.
For this reason, Dolezal developed shame competence training (www.shameandmedicine.org) that “aims to give practitioners skills to understand and manage shame.”
Shame competence also includes having a basic understanding of shame theory, understanding one’s own shame experiences, and both the dynamics of shame and patterns of how people avoid it.
While shame affects individuals in a very personal way, with feelings that range from feeling bad and wrong to humiliated and shunned, and leaves them having to contend with the emotion, the clinician shouldn’t view it as the individuals’ emotions or problems to solve alone. In fact, it’s pressure from the collective that has built energy for years—decades, centuries, even—that creates the moral distress in the individual. Realizing this is key to shame competence.
“Shame is difficult to discuss, so practitioners are often more comfortable talking about stigma,” Dolezal says, adding that while “stigma has a lot of traction in health research, it points to societal and political machinations”—like unfair social norms, for example. And, because shame is painful, practitioners may hesitate to bring it up. “You can have shame competence without saying the word shame,” Dolezal says. “If you can recognize this discomfort within yourself, you can help recognize emotional dynamics without ‘othering’ the patient.” Othering creates a transactional kind of interaction rather than a relational one, the latter of which is the goal, she adds.
Understanding and Holding Shame in Clinical Practice
This means looking at the social process, beginning with the family system. For children—infants—the family system is the social context and the social reality. It’s when and where a sense of self begins to develop. While we commonly understand that we internalize messages from the family context, a larger question looms, Gibson says: Where did the messages originally come from that the family is holding themselves? How are others in the family, and then, by virtue of those family members venturing out into the community at large, holding and conveying these messages—such as “You should be like this, but not like this.”
“The layers and layers of messaging about what someone should be are embedded into the foundations for shame and set a standard that the individual will inevitably be unable to live up to,” Gibson says, which amounts to “constantly competing with whom we are supposed to be in systems that don’t allow us to be human. And then we don’t want to talk about shame because we don’t want to let people know we feel bad or feel less than them.” As shame messaging is extrapolated across families, towns, cities, countries, and the world, we can see how its potency becomes entrenched. However, as shame sensitivity becomes more the norm, we can surmise that its effects can be powerful and pivotal.
“Shame sensitivity is not shame avoidance,” Gibson says. “Can’t get rid of it, and perhaps you should not get rid of it. Growing from it is the aim, to understand how it got internalized and how this shaped you.” This growth could include a heightened sensitivity to the pain of others, for example, and a true empathy for those who suffer. In other words, integration of the experience vs trying to do away with the shame.
Bringing shame to consciousness is rigorous work for the individual and for the collective. An individual’s shift will affect the collective, the larger society, even in what may feel like a small way. But it’s a piece and an important one.
Shame Sensitivity on Campus
“The university or school setting is a microcosm of larger society,” says Emily Snyder, director of the department of student community development at Stony Brook University. An example of shame sensitivity on campus is the practice of elevating voices and stories within the community to help others by sharing experiences and vulnerabilities in a public capacity. “Our ability to use the tool of peers as influencers lends to the normalization of asking for help and seeking advisement,” she says.
“Shame and identity are so well worked into the fabric of each other that they can be difficult to separate,” says Ellen Driscoll, assistant dean of students and director of the student support team at Stony Brook University. “The whole shame thing is that ‘if I’m not good enough, I’m alone,’” Driscoll says. “Shame can be triggered when a young person enters college after being at the top of their high school class. They then come to a research university and it’s very challenging. What you’ve done in high school may not have prepared you for the academic rigor of college and it could be identity crushing.”
Snyder and Driscoll agree that it takes a great deal of intention and effort to create a shame-sensitive culture and that it must begin at the point of orientation and onboarding. These efforts are most effective when they engage the university community at large. It’s not enough to tell students to ask for help if they need it. Shame is a collective experience, and that is why the collective university community is mobilized to meet the student, not only in the middle but where they are—emotionally and literally.
Intentional integration, including a frequency of exposure in casual, public settings where a student might travel or visit on a daily basis as part of their regular routine (a dorm cafeteria or student union, for example), helps by letting the student build familiarity with various individuals in the extended support network should further support be needed for intervention. Social programming on campus—such as mini golf, talent shows, movie nights, or a mocktail event on welcome weekend hosted by the on-campus health and wellness department—are all ways to show students that the university culture sees the need for support as natural, something built into the framework of student life.
Snyder explains that this is different from a mental health fair—often staffed by mental health professionals—which focuses on the service itself and could be intimidating to an individual raised to not seek help for fear of looking weak or being a burden. Creating opportunities for people to build their networks with nonhelping professionals (those in student services, for example) before they need support is a subtle but powerful way to destigmatize shame without even having to mention the word shame itself. Such familiarity creates kinship before a need arises and allows for a referral to be made—either the student self-refers or the nonhelping professional accompanies the student (following discussion of needs) to mental health services.
This process integrates the support-network component, making it a natural extension of university life. “A big part of the puzzle is getting students connected and just knowing their people—people who they meet socially before they need them,” Snyder says. “We do this by taking support outside of a formalized setting by coordinating programming that has students engage with support professionals more casually to discuss, for example, how they are being impacted by their transition to college.” According to Snyder, support is infused into nearly all student affairs areas. “These partners are at the ready and taught to think through what may trigger shame.”
A shame-sensitive approach is one that recognizes that everyone experiences feelings of shame, often when individuals are not “guilty” of a wrongdoing. For social workers, in addition to bringing this awareness into the therapeutic relationship, it is helpful and necessary to understand how shame manifests in one’s own life. This includes reflecting on its origins, examining one’s own responses, and finding ways to transform the suffering into energy for growth. Discussions about shame, even divulging to oneself the pain of its intensity, is a good place to begin.
— Meredith Gordon, LCSW, worked in health care for two decades and maintains a strong interest in the expressive arts. She is the coauthor of All the Love: Healing Your Heart and Finding Meaning After Pregnancy Loss (https://alltheloveafterloss.com/book), and creator of the Shame Recovery Project and Surviving Narcissism Series (https://shamerecovery.com).
Shame in the LGBTQ Community: Tips for Clinicians From Erika Morris, JD, MA, LMFT
• Help clients understand that the depression and rage—and shame—that they have a difficult time getting through or getting over could be important clues that they could be feeling bad about themselves for something that they are legitimately mad at someone else for doing to them.
• Naming some of the unfavorable aspects of a collective past (a society’s, a culture’s, or a family’s, for example) can provide a longitudinal view of the issues pertaining to LGBTQ identity, as can examining myths and affirmative narratives about historical figures who were gay.
Tips for Clinicians From Valerie Gough, LMFT
• Help clients understand the conditioning from childhood so that they can grow to accept this was the way it was then, this is how it is now, and that there can be lag time before the change within feels real.
• Embrace the saying, “We’re all just walking each other home,” for the simplicity and beauty that it holds, meaning that we all experience shame, we all suffer from it, and kindness can be an antidote as we work through it.
2. Sheikh S. Cultural variations in shame's responses: a dynamic perspective. Pers Soc Psychol Rev. 2014;18(4):387-403.
3. Dolezal L, Gibson M. Beyond a trauma-informed approach and towards shame-sensitive practice. Humanit Soc Sci Commun. 2022;9:214.