My patient is angry and ashamed. Another fight with her boyfriend, another book thrown across the room. When the feeling rises up this strongly, she finds it almost impossible not to strike out in action. She does feel better for a moment afterward, until the wave of shame comes over her. She feels trapped, stuck; action and inaction both seem intolerable. “I have to make the feeling go away.”

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 My patient and I are doing therapy using the “TEAM” model, developed by David Burns. TEAM is an acronym that stands for T = Testing, E = Empathy, A = Analysis of Resistance, and M = Methods. “Analysis of Resistance,” also called “Agenda Setting,” lets us turn on its head our attitude about painful emotion: instead of seeing negative feelings as the problem, a sign of pathology or disorder, we can reflect on what is positive and important about them. As painful as they are to experience, our anger, guilt, shame, fear and sadness serve as critical signals and motivators, and reflect our deepest held values for ourselves and the world. Something remarkable happens when we shift our attention to notice this.

 My patient and I are exploring a moment in time when she’d become so furious with her boyfriend that she felt an urge to destroy something. They’d been arguing over his not wanting to vacation with her family, and he had just said to her, “Don’t be so dramatic, you need to get ahold of yourself.” Feelings of shame and rage tumbled over each other inside her. She was filled with an urge to hurl the book at him, at the lamp next to the sofa, through the glass of the window. How could such a violent feeling possibly be a good thing? She takes some time with me to recall exactly how she was feeling.

She spoke slowly as she covered the painful terrain, alternating between glancing up at me and covering her eyes with her hands. “I was already hurt and angry that he wouldn’t spend time with my family, and then I felt like I was being condemned for being upset and hurt.” She paused, silent, and shaking. “I felt dismissed, wiped away, worthless.” She looked up at me, her face tight. “And then came rage, and that damn book, and yet and yet another round of shame, rage and shame, over and over.” Her shoulders sagged and she started to cry, shaking her head, “I just want to make the whole mess of feelings go away.”

In TEAM therapy, the analysis of resistance includes “the Magic Button question,” designed to help us see what is positive about our feelings.

“Yeah, I can see why you’d want to zap away those feelings. I’m wondering if we could do a little thought experiment. Let’s imagine you have a magic button, right here on the table next to you, and if you push that button, all of those negative feelings, the rage, and shame and hurt and feelings of worthlessness would be wiped away, with no effort at all. Would you push that button?”

“Of course! In a heartbeat!”

“That makes so much sense to me; but let’s be clear — we’d be saying you’d feel zero of any of these feelings, even though your boyfriend had just made that cutting comment; you wouldn’t react negatively at all. Is that what you’d want?”

She looked at me with a wan smile, “Okay, I guess I see your point, I don't want to be a robot.”

“Yeah, right. I’m actually thinking that your anger, your hurt, your shame — even that feeling of worthlessness — are important and actually positive. Let’s take the hurt and anger, for example. What is positive about those feelings?”

“Huh. I don’t know. I mean, what he said was actually kind of a dick thing to say.”

“I agree — it was kind of insulting, and then dismissive. Would it make sense to feel hurt and angry if someone close to you spoke to you that way?”

“I guess, yeah. I mean, I’d want to stand up for myself.”

“Yeah, like if someone stepped on our toe, you’d want to have awareness of pain?”

“Right, that makes sense, but I’m not sure I’d want to feel so much rage and shame that I felt like hurting him.”

“Probably not — we’ll get to that in a second, but let’s focus on what’s important and positive about your feelings. What does it say about you that you’d get angry if someone isn’t treating you well?”

“Well, that I care about myself.”

“Right, exactly! Can we start writing these down?”

Together, the two of us started to note down what was positive about her negative feelings — that her anger served as a signal that her boyfriend has crossed a boundary and said something hurtful to her, that she cared about herself and doesn’t want to be a doormat.

“But what about that shame feeling and feeling worthless — how can those possibly be good?” she asks me.

“Excellent question — can you think of anything?”

“Well, I guess it shows I’m not shameless,” she says dryly.

We both laugh.

“Ha ha! Yes, right — and what does that mean, to be shameless?”

“Well, someone who is shameless really doesn’t care about their behavior. I felt ashamed because I had lost control, and I wanted to hurt my boyfriend. You know, he can be a dickhead sometimes, but I actually do love him, and I really don't want to hurt him. I don't want to hurt anybody.”

“So, the fact that you felt shame means you cared about your behavior and your impact on others?”

“It was hard to see at that moment, but yeah, I suppose so. I mean, I didn’t throw the book at him, or even at that damn lamp. I just threw it at the wall, away from him.” She put her hand to her forehead and looked up at me sheepishly. “It made a mark on the wall. Actually, it made the third mark on that part of the wall. I guess that’s my book throwing place.”

“Oy!” I commiserate.

“Well, if we get this figured out and I stop throwing books, I can always repaint it,” she smiles. “No, but seriously, I think I’m getting the point here. My anger signaled that he said something hurtful, and then my shame let me know that my anger had gotten out of control and I was in danger of doing something I’d regret. And it’s funny, when I think of my feelings in that way, as carrying an important signal, or a message, I don’t feel as upset.”

“So, you don’t want to shoot the messenger?” I ask.

“Or I should at least read the message first!” she replies, “In a funny way, perhaps one reason I got so upset is because I had stopped listening to what my feelings were trying to tell me, so they had to get really loud for me to hear them. Maybe if I read the message, the messenger won’t become such a beast. How about if I worry less about the messenger, and start listening to the message?” 

File under: The Art of Psychotherapy