Megan came into session and sat down. Her eyes wandered around my face, but didn’t meet mine when she said, “I did it again. I went back to him.”

“Tell me,” I said, leaning forward.

“I’m a – a loser. I can’t stay away from him even though he’s bad for me.”

Megan had come into therapy after failing to sever ties with her most recent boyfriend, Tim, a man who repeatedly left her feeling emotionally abandoned and worthless. She reported a history of tumultuous intimate relationships that consistently left her feeling lonely and dissatisfied.

Tim was no different. Every time he dismissed her or invalidated her, it tore a little more of her heart out. Worse yet, it confirmed her inner fear: She was worthless and no one would ever, could ever love her. Trying to repair fractures to her self-esteem, she would search for the next man to love her, only to find herself in another relationship where she felt dismissed and worthless.

This isn’t unusual. It’s certainly a story I’ve heard variations of many times as a psychotherapist. Megan, who was thirty-five years old, reported that she had been going through this cycle since she was a teenager. She felt hopeless that she would ever find the stable, loving relationship she so wanted. I felt it as soon as we started our work together. Shame.

In my last blog post, I discussed the shame that entered the room in early sessions, when patients began exposing themselves. Megan’s shame was more complicated. Normal shame is transient, but for Megan, her inclination was to experience shame in all ambiguous situations. This proclivity has been assigned various names. I like to call it shame-proneness, which is the term June Price Tangney, one of the leaders in research on moral affects, (shame and guilt), named it.

When Megan came into situations that naturally elicited self-assessment, her emotional response would be feeling bad, small, defective. Self-esteem is a cognitive evaluation of the self; shame, on the other hand, is an affect, and therefore, permeates the entire self, spilling into every crack of someone’s being, coloring all their experience-darkly.

On some level, Megan believed that she deserved poor treatment from men, causing a repetition of the very pattern she was trying to stop. No matter how hard she tried to find a different outcome, she was always confronted with the same feelings of shame. Thus, the narrative – I am bad – that she desperately wanted to change, perpetuated itself.

Megan explained that she went back to Tim during the week when he promised it would be different, only to be left again. This was the fifth time she went back only to be left.

“He threw me out.” Tears trickled down her cheeks. “See, I’m weak. I’m a failure at everything. I’m never going to find what I want. It’s me.”

Her feeling bad about herself in the Tim situation pervaded other aspects of her life. That is, she felt bad all around, not just in relations to Tim.

I knew I had to help her see how her self-perception created a type of self-fulling prophecy. So, I reminded her of what we had been working on. “Remember what we talked about?” I often use psycho-education with patients, even when I’m working more psychoanalytically as I usually do with a shame-prone patient. I don’t find that keeping the nuances of therapeutic work undisclosed helps, especially for patients who feel so exposed already. It’s like throwing them outside in the cold without a coat, alone.

Megan and I had discussed shame. She knew that it tied back to early experiences of emotional neglect and abuse, where she unfortunately heard messages that she was bad and wouldn’t be anything different, ever.

“I remember, that just makes me feel worse. I should know better by now,” she whispered. This is where shame is so tricky; it’s very hard to intervene without evoking more shame.

I addressed her experience in the room. “We knew it would be hard not to go back if he called. Intellectual insight comes before the emotional connections that make change easier. You are working very hard to undo a narrative that took years to build. It takes time.” I leaned forward, again. “Remember, what we talked about last session, during the break from Tim.”

“Yes, I’ve – gosh, I can’t believe I forgot.” She pulled out her phone and showed me a schedule of all the workouts she had done the last week. Megan had been very athletic. I encouraged her to go back to exercising.

I wanted her to feel her strength and resilience. I wanted her to find her value in her activities. One of the most effective ways to help people combat these shame narratives is to help them access and activate their natural strengths, the parts of them that weren’t fostered, because no one acknowledged them when they were younger.

It’s our job as clinicians to discover these natural endowments and cultivate them for all of our patients. Shame-prone patients need more help figuring out what they are and more time to develop motivation.
Megan smiled as she showed me what she had accomplished that week. I saw pride glowing in her eyes. I observed it with her. “What are feeling?”

“I feel good.”

I smiled, thinking that we had found a space for Megan that was shame free. “What’s it like to feel good?”

“It’s something I knew I wanted to feel, but I could never quite find.”

“Now that you know what it feels like, it will start to get a little easier. Be hopeful.”

“I am.”

*Megan is an amalgamate of patients suffering from shame-proneness.

File under: The Art of Psychotherapy