Joseph Burgo on Shame, Narcissism and the Art of Empathy

Joseph Burgo on Shame, Narcissism and the Art of Empathy

by Lawrence Rubin
For psychotherapist Joseph Burgo, shame and narcissism are resources awaiting the delicate hand of the empathetic clinician.


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A Personal Journey

Lawrence Rubin: You’ve been a practicing psychotherapist for over 30 years and have authored several best-selling clinical books. You seem fascinated by the clinical concept of shame. What’s its appeal to you personally and professionally?
Joseph Burgo: I guess it begins personally because for the last 15 years I’ve been coming to terms with my own shame, learning to recognize the role it has played in my life that I didn’t quite understand even at the end of my analysis. During that time I’ve been applying my new understanding to my clients in my clinical practice, and writing a book about it that would be helpful to people who aren’t necessarily in therapy. So, I suppose it’s the case that when you’ve been researching, and writing and thinking about something for a while, it takes a central role in your life.
Right now, it seems to me like shame explains almost everything
Right now, it seems to me like shame explains almost everything.
LR: It seems to be a really elastic concept that can be applied to all forms of pathology and client presentation. What kind of therapist do you think you were before you worked through your own shame issues?
JB: I was a blank-screen, classical sort of psychoanalyst trained in the object-relations school—Melanie Klein, Donald Winnicott, those people. I focused on issues of need and dependency because, from the object relations framework, everything is viewed in the context of maternal-infant relationships—what it’s like for a baby to depend upon her mother and the emotional impact when dependency doesn’t go very well. This is when the infant must protect itself from unbearable feelings of pain and disappointment.

That was the old paradigm. I wouldn’t say that I don’t think that way anymore, but I focus more now on shame and self-esteem. I don’t like the word self-esteem but it’s the word we’re stuck with. I focus more on shame and defenses against shame, the way we protect ourselves against feelings of defect and unworthiness, rather than defending against feelings of neediness and helplessness. 
LR: If your personal work on shame has allowed you to be freer of its pull, would you say that, irrespective of the type of therapy you practice, you’ve become a better or different therapist as a result of your own resolved shame issues?
JB: I like to think so. I’ve become a more empathic therapist for sure. I’ve always been empathic and had the ability to empathize with what my clients were going through, but for too many years I regarded that as information I needed to use in order to formulate interpretations. I still do that, but often now it means that I need to say something a little more personal or more directly empathic like speaking to the agony of their shame and letting them know that I have felt that way too. I understand what they’re going through in a way that isn’t distant, isn’t intellectual, but is immediate and authentic.
I’m much more likely to communicate my affection for my clients because I think that feeling joy and interest from another person is a very healing experience
I’m much more likely to communicate my affection for my clients because I think that feeling joy and interest from another person is a very healing experience. It isn’t enough just to make interpretations.
LR: That’s interesting because somewhere in my readings about or by you, you said that clients must wait for their therapists to grow enough to be able to help them. Is that what we’re talking about here?
JB: It is, and when I wrote that I was thinking in particular about two of my very long-term clients who went through a fallow period in their therapy until I addressed my own shame, and then understood shame better and could help them address theirs. That took a while. And it’s interesting that one of them will sometimes refer back to that period when I hadn’t quite figured it out as a fallow period, when we were kind of spinning our wheels.
LR: That fallow portion of the therapy was in part influenced by the growth that you had not yet made!
JB: I think eventually I was able to communicate that to them. However, in the beginning of that fallow period, I defended myself. I had been giving the correct interpretations, but they weren’t making use of them. I didn’t say that, but I think that was my attitude, and it was a somewhat blaming attitude.
LR: It must have been very empowering for you and those particular clients to reach out of that fallowness and find your ways to growth.
JB: It was. It was very productive. It was very moving and relieving that we found a way through that impasse.
LR: You also mentioned that you’ve been most successful in helping those clients whom you have found endearing. Has your own growth around shame allowed you to find clients more endearing and maybe, by association, have you felt more endearing?
JB: I don’t think so. I think this has been a feature of my work from the very beginning. The longest-term client I’ve dealt with, who I’ve mentioned in some of my writing, is very difficult, very volatile, probably in the realm of borderline personality disorder. And yet, endearing to me from day one for some reason. I don't know why, and that was many, many years ago.
LR: Do you find that you’ve become more endearing as a person and a therapist as a result of the work you’ve done on your own shame?
JB: It’s something I hadn’t thought about before. I know I’ve become warmer, more accessible, less intimidating for sure. I don't know if I’ve become more endearing. I think to my closest friends, yeah, probably. They will remark on how I’ve changed.
LR: What are some of the signs that a therapist is being overly influenced by their own shame to the point that it’s adversely affecting their work?
JB: I would say that one of the most common ways is for the therapist to hide behind their professional role and to allow clients to view them in an idealized light--as if they’ve got it all together. This sustains a therapist’s own defenses against their shame. I think this is common, and you hear about therapists who are amazing to their clients, adored by them, and their personal life is a disaster.

The Value of Shame

LR: What do therapists need to understand about working with clients whose pathology is shame-based? Clients don’t come in wearing t-shirts saying, “I’m shame-based.”
JB: I think there are several things. First, I think we need to expand our idea of what shame is.
We’re stuck in this paradigm in which shame is viewed as this uniformly bad thing
We’re stuck in this paradigm in which shame is viewed as this uniformly bad thing, and it usually has to do with some intolerant social perspective, some way that people are influenced by perfectionism and intolerance in the broader culture, and the work of John Bradshaw and toxic shaming. That’s the way we view it. That’s one of the things I try to challenge in my new book, to help people, both clients and therapists, look at shame as something else. The other thing I’m trying to do in that book is to look at the ways that everybody defends against shame. There are a consistent set of defenses that people use when shame is unbearable in their lives. I talk about as avoiding shame, which is in the realm of social anxiety; denying shame, which focuses on narcissistic issues; and controlling shame, which is more in the realm of masochism and self-deprecation.

I think you have to learn to recognize a defense against shame, understand what it is, and then help the person to gradually, over time, defend less against it, understand what it is that they’re running from and learn from it. Sometimes, when we’re behaving in ways that we don’t respect, we have a lesson to learn about our behavior, and shame is a message to us that we need to take a look at ourselves. Sometimes shame is telling us we need to try harder and that we’re not holding ourselves accountable. Sometimes shame is telling us that we have some room to grow. That’s a way I really try to reframe shame as an opportunity for growth rather than this uniformly bad thing.
LR: If we look at shame as part of being a human, we can then consider whether it is serving us and how we can develop a new relationship with it so that there’s more room for growth.
JB: I think so. I think that’s a good description.
LR: You wrote about a client named Caleb, the one we highlighted in the excerpt on this site in a chapter called “Superiority and Contempt.” Upon reading, I didn’t like him and know that you struggled to feel connected with and empathetic toward him. What impact did he and clients like him have on you?
JB: It’s a challenge working with a client like that because your own feelings of worth are impacted. Intentionally and inevitably, when a client like Caleb is in flight from their own shame and defending against it, they will often project it onto other people and then hold them in contempt as inferior and defective. Even though I’ve evolved a lot, I still see the transference and the working relationship between therapist and client as a microcosm of the client’s issues, and often the best way to address them.

Caleb was always trying to make me feel inferior, that he was better than me, that I wasn’t very smart and that I wasn’t very insightful
Caleb was always trying to make me feel inferior, that he was better than me, that I wasn’t very smart and that I wasn’t very insightful. If you’re not aware it’s very easy to become defensive and to make the sort of interpretation that might be shaming to the client, or to sort of shore yourself up, and end up in a tit-for-tat relationship. It’s a conversation that’s being had beneath the conversation in therapy.
LR: Exactly. This very morning, I had to decide to delete a contact from my phone contact list, a guy that I’ve known for 50 years. We are in a constant tit-for-tat, but it seemed that at the core was his need to shame me. He finally stopped communicating with me, and then I texted him on his birthday and got no response. I texted him again yesterday with no response, and this morning I was thinking, and this was my own shame talking, “What can I say that will shame him the most deeply?” And I came up with a perfectly crafted text that would have probably put him through the roof, but instead I decided that that’s sort of a poison you take waiting for someone else to die, so I just said “the heck with it,” and deleted his contact.
JB: The difficult thing about that experience is when someone doesn’t communicate with you and ignores your texts, what they’re saying to you is that you are unworthy of their attention, which is shaming. It’s painful when you express interest in somebody else and they don’t return it. That’s a kind of shame, and it’s natural for people to want to retaliate in kind and to say, “No, you’re the one who ought to feel ashamed.” But you did really do the right thing, which was to recognize that you wanted to shame him, and then decide not to do it.

The Flip Side

LR: We seem to be in a golden age of narcissism. A few years ago, you wrote, The Narcissist You Know. Why are we all so fascinated by narcissism? 
JB: Well, I will start off by saying that nobody wanted a book on shame. I originally tried to sell a book on shame about 10 years ago. It was called Learning from Shame: The Less Traveled Road to Self-Esteem, and nobody wanted it. I was told by agents and editors that the book was a downer and that nobody wanted to read about shame. So, I said, well okay, I will then write a book about narcissism, which I see as the flip side of shame, because everybody’s interested in narcissism right now.

I think that
as a culture we’re fascinated by narcissism in the wrong way. I think we’re not horrified enough by it
as a culture we’re fascinated by narcissism in the wrong way. I think we’re not horrified enough by it. We’re not repelled enough by it. We’re fascinated by it because we really enjoy these images of people--particularly celebrities--who seem to have it all, who are beautiful, rich and successful, and we like to believe that somebody actually does get to have that ideal life. Then we spend our time on Facebook, Instagram, and Twitter convincing everybody else that we’re leading this incredible life, that we have these amazing vacations, and we go to these fantastic parties, and here’s this amazing meal I’m having at this incredible restaurant. It all feels really unhealthy to me. 
LR: So, narcissism is a destination for people in hopes that once they are on display and revered, they will be able to escape shame? So, as you say, narcissism the flip side of shame?
JB: Yes it is. It’s the primary defense against shame, to disprove to everybody else and yourself that you’re damaged in any way.
LR: What’s interesting to me is that both are equally illusory and not tangible, though both can have tangible impacts on the body and mind. They seem so illusory but so powerful in their ability to just take over a person and deprive them of a true sense of self.
JB: Well, I agree. I think the problem is that for the narcissist, shame feels like an actual condition, an actual state of being in which they’re damaged, defective, ugly. It’s felt on an almost physical level to be a real sort of damage, a deformity, and that’s unbearable. So, they try to create this opposite steady state, this idealized self, that’s perfect and complete, which completely denies the existence of that other steady state: shame and the sense of being damaged.

That’s the problem I see.
The quandary for the narcissist is that either you’re perfect and you’ve got it all together—you’re fabulous; or you’re so damaged and defective that you’re beyond hope and there’s nothing to be done
The quandary for the narcissist is that either you’re perfect and you’ve got it all together—you’re fabulous; or you’re so damaged and defective that you’re beyond hope and there’s nothing to be done. 
LR: And it makes sense that the dichotomy of shame and narcissism are part of borderline functioning, this either-or, black or white, idealized or brutalized images of others.
JB: Absolutely.
LR: Is that why in your writing and thinking you’re drawn to borderline pathology--because it is the epitome of this dual narcissism-shame quandary?
JB: I also see the same issue in bipolar disorder. You see people vacillating between thinking that everything about themselves is so damaged, so screwed up that it’s hopeless, and then going on a manic flight into some magical state in which none of that’s true; they’re super powerful, super capable, they can do anything. I see the polarity not only in borderline symptoms but also in bipolar symptoms.
LR: We seem to be so caught up in seeing bipolar disorder as a so-called emotional disorder of dysregulation, so we medicate people for it. But the medication is not going to modify the core dynamic that drives the bipolar behavior, which is the vacillation between shame and narcissism.
JB: Exactly.

The Challenge of Treatment

LR: What are the clinical challenges of working with narcissistic clients, especially those whose narcissism is considered toxic? It must be very trying and demanding for a therapist.
JB: Well, yes. But the truth is that the people who have extreme narcissistic symptomatology usually don’t come for therapy. They think they’re fine or they’ve got some other mechanism for dealing with it that doesn’t involve acknowledging their own difficulties and asking for help. But when they do come, it is a challenge, whether or not you’re dealing with someone like Caleb, the therapist client we were talking about who projected shame into me, or some of the clients who struggle with borderline symptom.s People who have struggled with borderline symptoms are challenging because they go back and forth between idealizing you and hating your guts. As the transference gets underway, it’s a very volatile and emotionally immediate relationship in which what’s going on between you and how you’re viewed is at the core of the work. It’s very painful to have clients say, “Fuck you. I hate your guts. You’re a leech feeding off my neediness,” and on and on and on. I’ve had clients say the most vicious things to me over my career, and the hard part is that the clients I’m describing often are very insightful in certain ways, like they’re able to identify something true about you but use it against you in a really hurtful way. So, your own issues get stirred up. Are you going to defend against that because it’s so painful? Or are you going to hear it and maybe learn something from it yourself? I don't know. I would say
I’ve grown the most with my clients who were the most difficult
I’ve grown the most with my clients who were the most difficult.
LR: I can imagine that a therapist who’s not done their personal work around shame and whose self-esteem vacillates would have the most difficulty and be caught up in the most damaging counter-transference relationships with clients like this.
JB: I think so, and I think those clients probably don’t stay very long with that type of therapist.
LR: I briefly had a client who I really messed up with because he was like Caleb, but younger and much more energetic, and I constantly found myself trying to prove myself. And there are some clients I’ve had that I wish I could call now and say, “I’ve grown. Can you come back and give me another try. I think I could help.”
JB: Oh, do I know that feeling. And the shame of failure. I feel that.
LR: Some people reify therapists, perhaps out of their own shame and inadequacy. We are the mental health celebrities, the equivalent of the celebrity athletes who they idolize. Then when we fail in their eyes we also fail in our own.
JB: Yes, absolutely. It’s kind of nice to be idealized in the beginning. It can easily feel great that somebody thinks you’re a really together person, and you’re full of insight and empathy, and they look up to you and want your attention. That’s flattering, right?
LR: Until it’s not.
JB: Until it’s not. Until they flip to the other side.
LR: You got that little thing there, doctor, in your teeth and now I’m going to just tear you to shreds.
JB: Exactly.
LR: It seems that working with these complex, characterologically involved clients is not about going to an evidence-based manual and pulling out a couple of techniques drawn from a meta-analysis. It’s not that kind of approach. Can you say a few words about the orientation, beyond technique, that’s necessary to work with narcissistically damaged or shame-influenced clients?
JB: It’s a very personal experience for the therapist because inevitably you’re going to be triggered and your own narcissistic issues are going to be stirred up. So, working with that kind of client means that you have to be paying a lot of attention to yourself. You have to be learning and growing from your shame experiences and acknowledging when you’re off base, when you make a mistake, when your interpretations aren’t helpful, and modeling a kind of ability to tolerate shame experiences and to learn from them for your client. So, it’s really personal, I think.
LR: I’m just sort of wandering back to this morning and how I spent 15 minutes crafting the most toxic, shaming message I could to someone who seemed hell-bent on diminishing me over the years, five decades, and how liberating it was, although painful, to delete his contact. Not that I couldn’t find him if I needed to, but the symbolic gesture of saying to myself, “I won’t allow myself to be shamed in this way anymore because I don’t need to pursue shame.” It came with the package.
JB: But they key element there, I think, is that you said it was painful.
Too often I think we want to take flight into some sort of superior position where we don’t feel any pain
Too often I think we want to take flight into some sort of superior position where we don’t feel any pain. We want to think “In fact, they weren’t worth wanting anyway. They were a terrible friend and I don’t really care about them.” That’s an understandable position to take. I always think that allegory of the fox and the grapes explains so many things. That’s one position we can take but what you said is, “Look, this isn’t good for me because this hurts me.”
LR: The allegory of the fox and the grapes?
JB: It’s the “sour grapes” story. There are some grapes hanging over the wall and the fox keeps jumping up to try and get them because they look so yummy. And then when he can’t he finally decides, well, they were probably sour anyway, I didn’t want them.

Rebuilding Esteem

LR: You have been interviewed by countless folks like me. You’ve offered your words in a public venue. You’ve written, so your words are out there. Does this feed your narcissism in a good way or bad way?
JB: I’d say both. In my new book I talk about how the real antidote to deep feelings of shame is to behave in ways and achieve things that build self-respect and pride to sort of off-set this sense of defect and damage. That has been absolutely true for me. I was at a low point in my life following the economic downturn in 2008 and 2009, following the end of my first marriage. I was just feeling bad about myself. The temptation was to sort of give up and to sink into despair. But I worked hard instead to build my website, rebuild my practice, write my first, second and third books, and to become an authority in some sense on a number of subjects that matter to me. I would call that healthy narcissism, building pride and self-respect, and I feel so much better about myself now than I did 10 years ago.

At the same time there’s a part of me that wonders: Why aren’t I Brene Brown? Why don’t I have my TED Talk?
At the same time there’s a part of me that wonders: Why aren’t I Brene Brown? Why don’t I have my TED Talk? And why aren’t I a public authority who’s making lots and lots of money off very similar ideas? So, I think there’s an unhealthy sort of narcissism that wants me to be bigger and better than I am. 
LR: I understand in ways that sort of transcend this interview. My work with came at a really good time for me. I was a low point professionally, just tired and drained. Teaching but not giving, more withholding than anything else, and wondering how much I really knew and protecting what little was left of my energy and empathy. I feel good about what I do know and what I’ve learned. I feel better about myself, so I think there are those of us who, like you said, embrace opportunities to escape shame and others see shame as sort of a deceptive friend that we can’t quite let go.
JB: That illustrates exactly what I’m trying to say in the book. There was a choice point in your life. You could have continued in that kind of ungiving way. You could have abandoned your profession and looked for something else, or you could find this opportunity that allowed you to apply everything you knew in this new framework where you felt good about yourself. You built self-esteem by doing something you feel good about.

Exploring Defenses

LR: We’ve been talking about shame and narcissism, your training, and your own professional evolution. It seems that at the core of your understanding and your work is the notion of defense mechanisms. You wrote a book called, “Why Do I Do That?: Psychological Defense Mechanisms and the Hidden Way They Shape Our Lives.” Is it always necessary to attend to a client’s defense mechanisms? And if we don’t, is the therapy doomed to a lesser level of effectiveness?
JB: No, I don’t think so. We all have defenses. We couldn’t get through life without our defenses, and some defenses are healthy and helpful. I don’t think those need to be pointed out or challenged. But, when defense mechanisms are deeply entrenched and pervasive, they get in the way of everything. And that’s why we have to draw our clients’ attention to them and help them understand what they’re defending against, so that they can deal with the pain in a more constructive way. For example, narcissism is a defense against shame, and we need to help our clients see how their defenses—their narcissistic behaviors that are meant to defend against shame—are causing all sorts of trouble in their lives, and that the solution is worse than the problem.
LR: So, if a therapist is not psychodynamically trained, and does not understand how to work with defenses and is themselves shame-based or defended against shame through narcissism, is the therapy doomed to a lesser level of positive outcome if for whatever reason defenses don’t get acknowledged or worked through? Is it just going to be patchwork?
JB: I think that a lot of growth and development can occur even if somebody doesn’t think the way I do. Even if they don’t view people in terms of their defensive structures or they don’t see shame in narcissism the way I do, lots of growth can occur. There are a lot of great cognitive behavioral therapists who are helping people, but certain issues aren’t going to get addressed, that’s all. I think that the deeper, more profound issues aren’t going to be addressed. That doesn’t mean it’s not helpful.
LR: The book itself is a self-help manual. I agree, as you said, that a lot of good work has been done by CBT therapists. There are apps for CBT. There are self-help manuals for CBT. Is a self-help manual for dealing with defense mechanisms really going to be helpful without the supplemental work with a real live therapist?
JB: I have clients who have asked me the same question and challenged me on having written self-help books. I don’t know. I do know that I hear from people all the time who have read my book saying how helpful it was to them and how it opened their eyes to themselves and they saw things they hadn’t seen before. You know, I just feel that most people can’t afford therapy. That’s the bottom line. Are we just supposed to say, “Well, you can’t afford therapy, so you’re doomed?” Or do we try to find some way to bring these ideas that inform our practices into a book that people can read, and offer them exercises that they can work on? I feel kind of obligation to do that.

Digital Empathy

LR: As we wind down, I want to draw attention to your involvement with distance therapy for these last five years. What are some of the advantages and disadvantages that you see in this delivery method?
JB: Mostly I see advantages because it gives people the opportunity to have contact with a professional when there isn’t anybody they can see face-to-face. I’ve worked with ex-pats in other countries where there isn’t anybody available. I’m thinking of a client I work with who is married to a Japanese woman and lived and taught in Japan. He couldn’t find anybody there that really would be able to understand him and his culture. So, there’s that great advantage, or there are places where there just isn’t anybody.

It’s usually very convenient for everybody involved, but sometimes there are obstacles. The client might live with somebody else so privacy can be a challenge. When I was in analysis it was really time consuming because I had to leave enough time for traveling and parking. When you do it digitally, you can log on and have your session and then you’re done with it.

Other therapists are often very skeptical about the fact that you’re not in the same room and feel that that might mean there’s a lack of immediacy and lack of a real personal empathic connection. I understand that, and I understand that’s got to be true to some extent but, especially after researching how empathy works in my last book, it’s not magic, and it doesn’t necessarily have to do with physical proximity. When we empathize with other people, we are reading their emotional experience on their faces, and we are unconsciously bringing our own facial expressions into alignment with theirs, which stimulates an echo of their experience inside of us. You can do that on a video screen, and I do.
I do feel a deep empathic connection with my clients when we’re face-to-face over a computer
I do feel a deep empathic connection with my clients when we’re face-to-face over a computer. I have worked by telephone. I won’t do it anymore because it’s so inferior if you can’t see somebody’s face.

The other thing is there’s often an extra bit of information that comes with seeing a client in her own milieu that you don’t get when they come to your office. That’s your terrain, right? I wrote an article for The New York Times about some of my clients who have pets and who connect from their homes, and how I get to watch them interact with their animals and I learn things about them that way. You learn things about people by what they choose to include in the video frame for their sessions. You sometimes have intrusions from people who forget that your client is in session then and they’ll come into the room or there’ll be sound from another room in the home. There’s all these extra bits of information that make it a very rich experience.

I do understand the reluctance of some therapists to work this way, and the sort of mystical view of empathy as this kind of ESP that happens when people are physically in the same space, but my experience tells me otherwise.

One of the personal bonuses of working in distance therapy is just this exposure to all these people I never would have had the chance to meet and work with on the west side of Los Angeles. It affords me the freedom to transcend the only thing I have never liked about my job, which is that I’m stuck in one place. I spent two months in Europe this summer and I worked the whole time. It’s always been my dream to not be a tourist but to just go somewhere and have my daily life there. I would do what I would normally do but at the end of the day rather than being home in Los Angeles or Palm Springs, I’d be in London or Paris, which is what I did, and it was fabulous.
LR: So, doing distance therapy can be liberating in that you’re in many places by virtue of the clients with whom you’re working, but you can also be in many places and sort of get filled up in that way.
JB: That’s a good way of putting it.
Distance therapy feeds me, and it makes me a happier therapist to be able to do that
Distance therapy feeds me, and it makes me a happier therapist to be able to do that.
LR: A happier therapist is a better therapist.
JB: Yes.
LR: Has it expanded your world view as a therapist in addition to making you a happier therapist?
JB: I like to think so. It’s kind of a humbling experience. I remember I was working with a man who came from a wealthy family in India. He had grown up in India, then been educated at boarding school in England, and was presently working in a family business in Dubai. There were so many aspects of his experience that I had to keep reminding myself that my set of cultural assumptions really weren’t going to hold true for this guy. I just had to listen and learn a lot about his experience and not try and impose my own fully Westernized values on him. It was challenging.
LR: I would imagine that the ability to rise to that challenge is based on one’s humility, but as you said, it is about empathy--the willingness to open yourself to others no matter who they are, where they are, and how they struggle.
JB: People might have different sets of cultural values and assumptions but their faces all express emotion in the same way. That’s biological.
LR: I guess that is as good a place to stop as any. Thanks so much for your time today and the wonderful conversation.
JB: I really enjoyed this interview, it was different from many that I’ve had before. Thank you for reading my books and for giving me the opportunity just to go on at length about subjects that mean a lot to me. This was very enjoyable.

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Joseph Burgo Joseph Burgo, PhD, has practiced psychotherapy for more than 30 years, holding licenses as a marriage and family therapist and clinical psychologist. He earned his undergraduate degree at UCLA and his masters and doctorate at California Graduate Institute in Los Angeles. He is also a graduate psychoanalyst and has served as a board member, officer and instructor at a component society of the International Psychoanalytic Association. He is the author of Why Do I Do That? Psychology Defense Mechanisms and the Hidden Ways They Shape Our Lives (New Rise Press, 2012) and the forthcoming The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me Age (Touchstone, September 2015).

He currently writes the popular blog, After Psychotherapy, where he discusses personal growth issues from a psychodynamic perspective. Working with clients all over the world, he also practices face-to-face video psychotherapy on a secure internet platform.
Lawrence Rubin Lawrence ‘Larry’ Rubin, PhD, ABPP, is a Florida licensed psychologist, and registered play therapist. He currently teaches in the doctoral program in Psychology at Nova Southeastern University and retired Professor of Counselor Education at St. Thomas University. A board-certified diplomate in clinical child and adolescent psychology, he has published numerous book chapters and edited volumes in psychotherapy and popular culture including the Handbook of Medical Play Therapy and Child Life: Interventions in Clinical and Medical Settings and Diagnosis and Treatment Planning Skills: A Popular Culture Casebook Approach. Larry is the editor at

CE credits: 1

Learning Objectives:

  • Discuss the ways that shame can be a resource for growth
  • Analyze the continuum of narcissism in your clients
  • Critique the notion that shame underlies narcissism

Articles are not approved by Association of Social Work Boards (ASWB) for CE. See complete list of CE approvals here