The following is an excerpt taken from Shame: Free Yourself, Find Joy, and Build True Self-Esteem, by Joseph Burgo, published by St. Martin’s Press © 2018 and reprinted with permission of the publisher.

Failure Happens

When therapists present their cases in professional papers to their colleagues, or in books like this one intended for a larger audience, they usually describe their success stories, putting their work forward in its best light. “Therapy often falls short, of course, and more often than we like to admit”. Sometimes we fail to form an emotional connection with our clients, or the limits in our understanding prevent us from helping them. Sometimes we make significant mistakes. And sometimes a client’s defenses actively thwart the insights and emotional support we offer them.

     I think the case I describe in this chapter reflects all those failures. At the same time it illustrates the challenges involved in working with clients who massively deny shame. I never found Caleb endearing in the way I did Anna (chapter 11). His arrogance and contempt were off-putting at times, and he rejected his own vulnerability so decisively that I struggled to connect with him on a deeper level. As a result I sometimes intervened too early or made interpretations that were too assertive, probably colored by my own wish to counteract his devaluation of me. At that point in my career I didn’t understand how core shame drives the narcissistic defenses.

        I was trained in the object relations school of psychoanalytic thought, which locates the root of most mental health problems in the early maternal-infant relationship. It focuses primarily on how it feels to be utterly helpless and dependent upon another person for everything you need. “Good enough” caregivers inspire confidence that, when you need other people, you can depend upon them to give you what you need, at least most of the time. When that early experience of need and dependency goes badly awry, however, according to object relations theory you will develop defenses against the awareness of such need.

     Denial: I don’t need anyone.

     Projection: You’re the needy one, not me.

     You may take flight into a grandiose fantasy of having everything you need within yourself or try to possess and assert control over those you depend upon so you don’t have to feel helpless.

     In my work today I focus less on defenses against need and more on the defenses against shame that lie at the heart of narcissism. The narcissistic defense reflects a complete denial that the person has any reason to feel shame. It does not arise from a self-aware choice but from the unconscious and lifelong rejection of a self that is felt to be defective, ugly, inferior, and unworthy of love. The haughty, I’m-better-than-you personality that the narcissist presents to the world masks profound shame, concealing it from himself and from everyone else. Unlike the shame experienced by clients whom I discussed in earlier chapters, Caleb’s shame was almost entirely invisible.

Introducing Caleb

Caleb, who was in his late twenties, was a therapist in training, working at a community mental health clinic whose interns I occasionally supervised. While personal therapy was not a requirement of his degree program or his internship, the clinic strongly recommended that its students enter therapy. For fledgling therapists, their first encounters with clients usually stir up so many strong feelings, tapping into their own emotional struggles, that therapy ought to be a requirement for anyone entering the field. Before he worked with me, Caleb had never seen a therapist. When the director of the clinic suggested he enter therapy, he resisted for many months and agreed only when she insisted.

     In a personal communication before Caleb called, the director told me “he was universally disliked by other interns at the clinic”. During staff meetings and group supervision he condescended to his peers, criticized their work, and continually tried to demonstrate superior insight. In group and individual supervision interns trained in psychodynamic psychotherapy present line-by-line accounts of their sessions, which they have usually transcribed from memory rather than audio recordings. When other interns in his group read their notes, Caleb often highlighted what he thought they had missed and showed them what he thought they should have said—and not in a way that felt particularly helpful. He competed with the group supervisor for prominence. After numerous complaints from other interns as well as his group supervisor, the director gave him a list of several therapists he might contact.

     No therapist wants to believe he was chosen for his lack of experience, of course; it has taken me decades (and some lessons in humility) to see that Caleb probably chose me because I was the youngest therapist on that list, without the professional stature of the others. I was only seven or eight years his senior. A highly competitive young man, he probably would have chosen a therapist whose level of experience he could more easily challenge and whom he had a good chance of defeating. From the beginning of our work together, “Caleb’s desire to render me useless, with nothing of value to offer, felt clear”.

     Most of us form quick impressions based on our first encounters with a stranger; therapists are no different, even if we’re more conscious of the observations we make and what we deduce from them. The clinic director’s description of Caleb had already colored my expectations. When I opened the door to my waiting room that first day, he was reading a magazine, a copy of The New Republic I kept there with some other reading material for my clients. He didn’t immediately glance up as I opened the door, as other clients typically do. With his gaze fixed on the page, he hesitated a few seconds, as if finishing that particular paragraph were of paramount importance. When he finally looked up, he smiled faintly.

     “Dr. Burgo,” he said, rising from the chair. In some ineffable way, the way he said my name felt condescending or ironic.

First Encounter

     Tall and well built, with broad shoulders, Caleb wore khaki pants, a starched white shirt, and a tie with deep blue lines against a vivid red background. His closely cropped blond hair gave him a vaguely military look, accentuated by his erect posture. (He had served in the army, I learned later in that session.) He cut an imposing, and subtly intimidating, figure.

     When he shook the hand I offered him, he barely took hold, gripping and soon letting go. He walked past me into my office, glanced around him in a leisurely way, as if assessing my furniture and wall art, then settled into the client chair opposite mine. He placed his right ankle over his left knee and gave me a look of mild expectation.

     “So tell me about why you’re here,” I said.

With a sober expression Caleb nodded. “Of course. Dr. Lewis suggested some personal therapy would help in my work.”

     “What about you? Do you think it will be helpful?”

     “I’m willing to give it a try.” Again the faint smile.

     Like Dean (a patient described in an earlier chapter), Caleb hadn’t come for therapy of his own volition, at least not entirely. I had similar doubts regarding the success of our work together.

     I asked about his family background. He willingly answered my questions but with minimal detail, in terse summary fashion, and almost as if he were doing me a favor. This impression became clear only much later. At the moment, “inexperienced in dealing with the subtle devaluation of clients like Caleb, I felt mildly ill at ease, not quite able to connect with him”.

     Caleb had grown up in the rural South, part of a large dysfunctional clan he described with clear disdain. Drug addicts and losers living on disability benefits—aunts and uncles, cousins, siblings—most of them unemployed and unemployable. Teen pregnancies, spousal abuse, and serial divorce were the norm. He was one of five children from his mother’s several marriages and had always felt like an outsider. Unlike everyone else in his family, he did well in school and took part in the ROTC program as a teenager. He spent four years in the military and later went to college on scholarship.

     The armed services provide stability and routine for many enlistees who come from chaotic family backgrounds. Sometimes it saves their lives. It also helps them to build pride through achievement, recognition, and a sense of belonging to a group whose values they respect and adopt. I believe the army had rescued Caleb from the horrible dysfunction of his family, but based on the few details he gave me, I gathered that he’d never made it a home the way many recruits do. He’d felt like an outsider in the army, too, never quite able to feel that he belonged. He made no close friends and formed no lasting bonds.

     “What about romantic relationships?” I asked.

     The military, college, and now graduate school had left him little time for such involvements, he told me, at least until recently. His current girlfriend, Katia, had been born in El Salvador and came to the United States with her parents when she was a small child. “She works as a property manager but goes to school at nights,” he said. “She won’t be satisfied to stay where she is. She’s ambitious. We wouldn’t be together if she weren’t.”

     Caleb’s words inspired a number of impressions I could sort out only later, after the session had ended. He seemed embarrassed that Katia was of Hispanic descent and worked at a job he clearly viewed as beneath her. He was quick to justify it as temporary, to align himself with a partner who shared his ambitions. As I grew accustomed to Caleb’s contempt and superiority, I began to feel sorry for Katia. He clearly viewed her as inferior; I suspected that those ambitions for her future were his and not hers.

Origins of Shame

     “How did you decide to become a therapist?” I asked. It seemed an unlikely choice of profession.

     “I’ve always wanted to help people,” he said. “Nobody ever helped me find a way. I had to do it all on my own, as crazy as it was. If I can make the struggle easier for other people, that’s got to be good.” He intended to work with inner-city kids eventually, he told me; he’d already begun to outline the type of program he wanted to establish. He couldn’t see himself fitting into the existing social services network operated by federal, state, and local government, which he dismissed with vague contempt. Funded by “forward-thinking philanthropies,” he wanted to found a private network of community centers integrating individual and group therapy in their offerings.

     I’m sure Caleb consciously believed what he said; on another level “a kind of grandiosity fueled this vision of his future”. Just as he fought against being “just one” of the interns at the clinic, he could never envision himself as a mere “cog in the wheel,” as he once put it. He couldn’t accept being part of an existing system and therefore planned to found his own network.

     “You see yourself as a leader and not a follower,” I said.

     “Exactly.”

     “Has it always been that way?”

     “What do you mean?”

     “How did that go in the army? I’ve never served, but I gather there’s an emphasis on hierarchy and following orders. What was that like for you as a new recruit?”

     “I understood my duty. I did what I was told.”

     “Any problems with authority?

     Caleb visibly stiffened. He didn’t like the question. “No.”

     At that point, based on what I’d heard from the clinic director and reinforced by what Caleb had told me himself, I made my first intervention. In retrospect it was probably premature. I no doubt wanted to demonstrate that I had something to offer and assert the authority I unconsciously felt him subverting.

     “It sounds to me like you have a hard time being young and inexperienced. Given your childhood, being small and dependent can’t have been easy. I wonder if you wanted to grow up all at once so you wouldn’t have to feel small.”

     Even if accurate, this wasn’t a particularly good interpretation. In the school of thought in which I trained, therapists are encouraged to provide insight before clients grasp it themselves, to shed light on the unconscious aspects of their communications that we hear and they don’t. Given that Caleb was a therapist in training, I also assumed that need and dependency issues would be familiar to him, a part of his own theoretical toolbox.

     “Interesting,” he said, with an interest that felt feigned. “How would I know if that’s true?”

     The question took me aback. “What do you mean?”

     “You say I don’t like feeling small and needy. That doesn’t fit with my experience of myself. But you may have greater insight than me. So how do I know if you’re right and I’m just missing something?”

     “If it doesn’t feel true, then it’s not helpful. It’s your experience and it’s ultimately up to you to decide. I can only tell you what I think might be true.”

     “But you have more experience than I do and you might see things that I don’t. Maybe I’m just being defensive.”

     “Possibly.”

     “So how can I tell if I am?”

     This particular interaction encapsulates my work with Caleb throughout the several months we worked together. When I made an observation, he often would wonder aloud how he was to know whether it was accurate. Sometimes he would offer an alternative hypothesis: “Couldn’t that just as easily be true?” he’d say. On one level he seemed cooperative and engaged, conceding that my experience as a therapist might enable me to observe things he couldn’t see; at the same time “he usually insisted that my interventions didn’t “feel true,”” sometimes offering an alternative hypothesis as if we were cotherapists.

Attempted Inroads

     Eventually I began remarking on the nature of those interactions. In psychodynamic psychotherapy the relationship between therapist and client sometimes becomes a focus: clients bring their emotional issues and styles of relating into the consulting room, interacting with their therapists in ways that shed useful light on their other relationships. Caleb’s view of himself as visionary leader, his condescension toward the other interns, his competition with his supervisor, and the way he reacted to my interventions felt all of a piece.

     “I think it’s hard for you to let yourself be a client,” I said more than once. “You’d rather be my peer than turn to me for help.”

     “I suppose that’s possible.” Caleb never contradicted me directly but instead raised doubts in a reasonable tone. “How would I know for sure that I’m doing that?” He appeared cooperative, willing to consider anything I might have to say, even if he never accepted any of it. His attitude toward me felt vaguely patronizing, as if I were his inferior and not terribly bright. The person who relies on narcissistic defenses against unconscious shame often offloads or projects his shame into other people around him, forcing them to feel it.

     “That sounds familiar,” he once said in response to my comment. “We were reading [Melanie] Klein’s paper on that subject in class last week. I think it’s “Envy and Gratitude.” She says something very similar to one of her own clients.”

     Caleb frequently shifted the focus from personal to intellectual. If I pointed out the subtle ways he dismissed and devalued me, he’d relate it to some theoretical paper he’d read. If I suggested that he found it humiliating to admit he needed help, he’d say how interesting he found the idea, then relate it to one of his own clients from the clinic. Over the years many of my clients have been therapists, and now and then they bring to our session their feelings of anguish or concern about their own clients. Caleb regularly discussed his clients in our sessions but never with any implicit bid for help. He recounted his fascinating insights and told me how much his clients felt helped by him.

     “Seems like you want to show me what a good therapist you are, rather than turning to me as your own therapist.”

     “Don’t other therapists you see talk about their cases? Dr. Lewis told me personal therapy would be a good place to talk about these things.”

     Such interactions made me feel useless and ineffective. “Nothing I said seemed helpful. I had no doubt that Caleb was devaluing and competing with me”, but I couldn’t find a way to help him see it. Because I was aware that he made me feel competitive in return, I was more cautious than I might have been in confronting him.

     He talked about one particular case more than the others. Celine, a young and apparently beautiful actress, formerly featured on a soap opera that filmed in New York, had recently moved to Los Angeles after being written out of the plotline. She was currently working part time as a cocktail waitress and chose the clinic for therapy because it charged clients on a sliding scale according to what they could afford. As the on-call therapist that week, Caleb had spoken to her on the phone and accepted her as a client.

     When he discussed Celine during our sessions, he seemed enchanted by her. Smart, well educated, lively, open and willing to do the hard work of psychotherapy. She readily accepted his insights and made good use of them during the time between their sessions. She often told Caleb how much she appreciated his help and considered herself fortunate to have wound up with such an excellent therapist, even if he was still in training. According to Caleb, she considered him brilliant.

     On the one hand this description of his sessions with Celine continued the pattern of one-upsmanship in our work together: He was brilliant and insightful, I was ineffective. On the other, I worried that this client was unconsciously playing to his narcissism because of her own needs and issues. For complex reasons some clients idealize their therapist during the early phases of treatment; they may feel a kind of elation at having found a savior. Especially for beginners in the profession eager to feel proficient, the experience of being worshipped by a client can be quite seductive. For Caleb it seemed like a kind of drug, confirming his idealized view of himself.

     I couldn’t speak with authority about Celine’s issues, of course, but in addition to his competitive feelings I did try to address Caleb’s wish to be idealized. I mentioned the anxiety and inevitable confusion that comes with being a fledgling therapist and how good it can feel to work with a client who reveres you. I talked about idealization as the flip side of hatred, a description I’d heard from my own supervisors. Caleb found this idea deeply interesting.

     “Klein writes about that,” he told me. “Splitting and idealization as a means of coping with ambivalence. Of course, that assumes she’s actually idealizing me.”
What I didn’t yet understand in my career was the role of unconscious shame in fueling this wish to be idealized. Hidden feelings of defect, ugliness, and inferiority may drive you into the arms of someone willing to agree that you are perfect.

An Abrupt Ending

     “It should come as no surprise that Caleb abruptly terminated his therapy without notice”. He left a phone message on my machine, telling me how much he appreciated my efforts but that he’d decided to seek help from someone “more senior.” He wished me the best of luck in my career.

     Because we worked in the same profession and he was an intern at a clinic where I occasionally supervised, I heard about Caleb from time to time. According to the clinic director, he waited months to mention that he had stopped treatment, and when it finally came out, he refused to pursue further therapy. He continued to be an irritant to staff and the other interns. Everyone looked forward to his departure from the clinic at the conclusion of his internship.

     Toward the end of his tenure one of his clients (I had no doubt it was Celine) filed an ethics charge against him for unprofessional behavior. According to the affidavit she filed with the board, Caleb had suggested they discontinue treatment and pursue a romantic relationship. He left the clinic not long after that, and I never heard from or about him again.

     Although some predatory therapists deliberately exploit their position of influence to take sexual advantage of their clients, others unwittingly succumb to the kind of idealization Caleb found so intoxicating. Based on their own emotional issues and needs, some clients unconsciously attempt to seduce their therapists; others idealize the person who helps them because of a deep longing to be rescued. When an idealizing client encounters a therapist in flight from shame, the results can be traumatic for the client and professionally ruinous for the therapist.