Tag: ADHD

The Polarizing Nature of Shame 

Posted on by Elizabeth Scozzari

The Long Shadow of Shame 

Shame often comes to me as a revelation that shakes me to my core. It has the power to suddenly evaporate every illusion I have about myself, which often leaves me feeling exposed and unworthy. Because of this, shame can also open the door to my deepest vulnerabilities, including childhood attachment fears, as it carries me into heavy emotions that sometimes feel impossible to hold. Shame is the most demanding internal experience for me, followed closely by grief.  

I don’t like to feel exposed and unworthy, so I typically and automatically try to avoid connecting with my shame. The possibility of experiencing shame is such an unwelcome experience for me at times that it can polarize my avoidance tendencies into two opposite and extreme positions: “the ideal” and “the victim”. These two positions are a safeguard in the short term because my shame does not immediately take hold of me. However, these polarized positions become problematic in the long term. They often initiate a destructive cycle of shame that can pull me deeper into my extreme positions by paradoxically producing more shame within me over time.  

The more common extreme position that I fall into is thinking that I am greater than I am. This polarized focus is something I like to term “the ideal.” Instead of acknowledging myself as I truly am, I attempt to act out an idealized version of who I want to be. This allows me to avoid my shame in the short term since I can remain focused on being an idealized version of myself. However, the shameful reality of who I truly am finds me in the long term when I inevitably fall short of that ideal. 

Unfortunately, the experience of me falling short of that unattainable ideal makes me experience even more shame, which intensifies my desire to avoid my shame once again by pretending that I am in fact closer to an ideal version of myself than I actually am. The only way for me to break free from this cycle is to acknowledge and bear the shameful reality of what I truly am in any given moment rather than trying to avoid that reality by thinking that I am already “the ideal.” 

Evoking the Ideal: The Case of David 

One of my clients, whom I will call David, serves as good example of how shame evokes the extreme position of “the ideal.” David initially sought counseling with me at the request of his partner. David’s partner thought he was struggling with undiagnosed ADHD due to his difficulty in attending to her and his responsibilities at home. She wanted him to get additional support. After working with David for a few sessions, the underlying pattern became quite clear. David had been placing an impossible pressure on himself to attend to all things in his desire to please his partner, and he did this by seeming like he was more capable than he was truly able to be.  

Instead of acknowledging his true capabilities and limits, he would begin to feel overwhelmed by all the responsibilities he would take on, which would then make him miss things that he would normally not forget. These actions would reinforce the shame of him being someone that is forgetful and/or not attentive, which would motivate him to try even harder to not be seen in that way. As this cycle became reinforced in his partnership, David’s shame amplified, and his depression got worse. When I first talked to him, he was nearing a psychological breaking point. He felt that he had somehow become the incapable person that he had been so desperately attempting to avoid. 

At the start of treatment, I encouraged David to be curious about his identity of being the incapable one. We explored the origins of this identity and uncovered his underlying overwhelm and deep sense of shame. As we explored David’s shame with love and acceptance, I also encouraged him to learn how to bear a little of his shame with me. David was able to realize that he was not the incapable person that he and his partner had come to know him as. He also came to slowly accept that he was not the highly capable person that he hoped he could be. He humbled himself and started to give realistic expectations towards himself and others in reference to his capabilities.  

His shame and depression faded, and his true capabilities began to grow as he gave himself space to start over with an honest understanding of who he was. Other people took notice of this shift in David. Instead of taking the bait and falling back into the belief that he was fully capable due to other people admiring his newfound capacity, he continued to humble himself and find slow, but persistent growth in his true capabilities. Through the course of our time together, David cultivated the qualities of the capable person that he always hoped he could become, not be forcing “the ideal” onto himself, but by paradoxically accepting that he was not yet that person. 

Overcoming the Victim Role: The Case of Avery 

The other opposing extreme position that I fall into is thinking that I am much less than I am. This polarized focus is something I like to term “the victim.” Instead of acknowledging myself as I truly am, I exaggerate my inadequacies to avoid facing the real imperfections that I do contain. This allows me to avoid experiencing my actual shame in the short term since I can remain a victim by focusing on all the negativity that I place on myself. However, the hopeful reality of who I truly am finds me in the long term as other people continue to remind me that I am more than I am pretending to be. 

Unfortunately, the uncovering of my victimhood makes me experience even more shame which intensifies my desire to avoid my shame once again by trying to convince myself that I am completely irredeemable. The only way for me to break this cycle is to acknowledge and bear the hopeful reality of what I truly am in any given moment rather than trying to avoid that reality by allowing myself to play “the victim.” 

One of my clients, whom I will call Avery, can serve as a useful example of how shame brings about the extreme position of “the victim.” Avery initially sought out counseling with me due to her worsening depressive symptoms. She had solidified a deep-seated belief through the course of her life that she was fundamentally unlovable and that her future was hopeless. She struggled with suicidal thoughts and felt as if most of her life was simply a constant battle for survival. After working with Avery for a few sessions, the underlying pattern began to emerge. Avery had become so terrified of accepting the possibility that she might truly be worth something that she trained herself to believe that she was in fact completely worthless to save herself from the shame of falling short of the real potential she did contain. 

Instead of acknowledging that she might have some level of significance as a human being, negative thoughts would quickly flood into her mind telling her that she couldn’t be more mistaken. These negative perceptions of herself would then make her feel worse about herself, which would only solidify her self-created identity as someone that is fundamentally irredeemable. As this cycle became reinforced in her own identity, Avery’s shame intensified, and her depression got worse. Her skewed sense of self had become so ingrained that the affirming comments that trusted others gave to her only made her feel more unworthy and alone. When I first talked to her, she was nearing a suicidal breaking point. She was seriously considering an act that would forever symbolize her fundamental sense of unworthiness in this world—taking her own life. 

At the start of treatment, I encouraged Avery to be curious about her identity of being the unworthy one. We explored the origins of this identity and uncovered her underlying fears of having to bear the real shame of her faults. As we explored Avery’s shame with love and acceptance, I also encouraged her to practice bearing a little of her shame with me. Avery was able to realize that her shame was not as scary as she initially feared. The negative perceptions of herself that she previously entertained were slowly replaced by images of her innate goodness as she learned how to embrace her shame in a real and healthy way. Avery’s newfound ability to be present to her shame also opened to her new avenues of growth as she welcomed higher aspects of her own goodness despite her fears of falling short of her potential.  

Her shame and depression faded, and her former hopelessness was replaced by a solid sense of self-worth as she cultivated the courage to start over with an honest understanding of who she was. Other people took notice of this shift in Avery. Instead of resisting their positive feedback and falling into her former belief of being unlovable, she allowed their love to enter her as she cultivated a healthier balance between her goodness and the ways in which she fell short of that goodness. Through the course of our time together, Avery cultivated qualities of the worthy person she secretly hoped she could become, not by pretending to be “the victim” of a cruel world, but by paradoxically accepting that she truly might be worthy of love. 

The middle path of shame amid both extremes is humility. It is the integrating virtue that allows us to cultivate freedom from these extreme positions by acknowledging that we are simultaneously a mix of good and not good enough. I always encourage my clients, along with myself, to work on bearing just a little shame. I don’t need to pretend that I am shameless, and I also don’t need to allow myself to be crushed by the weight of my shame. Bearing just a little shame opens the door of humility, which allows me to resist extremes and move through my shame in a redemptive and life-generating way. 

I must take a stance towards my shame. There will always be a risk that I orient toward my shame in a polarizing way, but attempting to avoid it altogether leaves me in an even worse place. The shame that I never acknowledge accumulates within me and only leads to more shame and isolation in the long term.  Shame is not something I can resist; it is something I must move through to find integration, healing, and wholeness. 

As a final note, I have always found it to be a deep irony that I tend to respond to my own experience of shame with avoidance and fear, but that I feel a deep sense of empathy, connection, and attention when I am in the presence of my clients experiencing their shame. I often consider how that experience as a therapist serves as a signpost for how I should be orienting towards my own shame. Though the process of shame can feel paradoxical and shrouded in mystery at times, the outcomes are always perfectly clear. The clients I have known that have truly become integrated, alive, and whole have been the clients that were courageously willing to face their shame and bear it in the presence of trusted others. 

What Autistic Kids Have Taught Me About Therapy

Posted on by Elizabeth Scozzari

I’ve spent years sitting on the floor with autistic kids who believe, long before they ever meet me, that they are the problem. Not because someone told them directly, but because they’re perceptive. They’ve absorbed the tension at home, the tightness in a parent’s voice, the helplessness after another school call, and the weight of adults who are out of options. 

A surprising number of the autistic children I meet can recite their diagnoses the way other kids list their favorite characters: ADHD, ASD, OCD, ODD, generalized anxiety, social anxiety, sensory processing disorder, mood dysregulation…on and on. 

They say these words with the matter-of-fact tone of someone who’s decided the only way to survive being treated like a problem is to name it first. When they sit across from me, small legs pulled up to their chest or folded tightly underneath them, their first question is something like, “Are you going to fix me? My dad says you’re here to fix me.” Kids don’t lie about this stuff. 

They report what they hear, and somewhere along the way, the professionals in their life—in an attempt to help, simplify, or categorize—stacked labels so high the child couldn’t see themselves anymore. That’s what autistic kids have taught me about therapy—the room becomes safer the moment we stop trying to fix them. 

When a Child Arrives Already Carrying Blame 

I’ve had children walk in and immediately seek the farthest corner of the room. I’ve seen kids tuck themselves inside the tent and whisper, “I know I’m the problem.” I’ve had children refuse to take off their backpack because they weren’t sure if they’d be allowed to stay. I don’t coax them out. I don’t insist they talk. I don’t ask for eye contact. I sit. I lower my voice. I match their posture. I wait. 

If all I do in that first session is show the child that I’m safe, that I won’t force vulnerability, and that I see them as a person—not a project—then the session has done its job. Many autistic kids communicate through energy before words; through pacing, breath, doll placement, construction patterns, retreat, play sequencing, and the way they use space. 

When I pay attention, the child is already talking. 

They show you: 

  • what feels overwhelming 
  • what feels grounding 
  • what feels predictable 
  • what feels too close 
  • what feels sensory-safe 
  • and where their nervous system sits on the ladder that day 

If I’m willing to enter their pacing—not impose mine—I get invited into their world. And that invitation is sacred. One child taught me this by accident. She was drawing spirals on the carpet with her finger—not talking, not looking at me. I followed her spiral with my breath, slowing as she slowed. I didn’t realize she was watching until she said quietly, “You breathe like me.” That was the moment I realized that I don’t need eye contact to build connection; I need attunement, as do they. 

Parents Don’t Come to Me Because They’re Cruel—They Come Because They’re Terrified 

I’ve worked with so many families who start with resignation, “We’ve tried everything.” “He’s going to get himself killed someday.” “She ruins every family outing.” “I can’t deal with her anymore.” “I don’t even like being around my own kid.” Years ago, those sentences pierced my chest. Now I listen for what they’re trying to say beneath the frustration. 

Parents aren’t villains in these stories. They’re exhausted humans who’ve been in survival mode for years. They’ve taken time off work for school meetings, fought insurance companies, been given contradictory advice, been judged by strangers, and weathered crises other parents can hardly imagine—elopement, medical trauma, meltdowns in public spaces, property destruction, suicidal ideation from a child too young to tie their own shoes––and the harshest words often hide the most fear. The more hopeless a parent sounds, the more likely they’re experiencing complete desperation. 

Once, after weeks of angry refrains, a father finally said, “I’m terrified. I don’t know how to help her. I don’t want to lose her.” I didn’t confront him. I didn’t correct him. I didn’t lecture him on parenting styles. I just let the truth settle, because that moment—when fear becomes visible—is where the real therapy began. 

Parents need a place to collapse too. They need someone who sees through the panic. They need someone who can interpret the emotional signal behind their words. If I look long enough, “She’s awful” usually means “I’m afraid I can’t protect her.” 

Why Control Matters So Much 

Some autistic kids arrive in therapy having had their choices stripped from them over and over; 
what they eat, what they wear, how they sit, what they focus on, how they talk, what stims they’re allowed to do, how they should “behave,” and what parts of their personality are acceptable. By the time they get to me, they assume adults will tell them who to be. So, I reverse the power dynamic. “You’re in charge here,” I tell them. Not metaphorically. Literally. 

They choose the: 

  • activity 
  • pace 
  • distance 
  • sensory input 
  • theme 
  • transition 
  • silence 
  • disclosure 
  • exit 

Some kids don’t test the boundary at all. Some test it immediately. Some test me for months. Autistic children who’ve been controlled harshly will often push against me to see if I’m just another adult who’s going to tighten the lid. But when they realize I’m not—when they learn I won’t force engagement, shame them for retreating, or push a conversation they didn’t choose—their nervous system relaxes. The rigidity softens. The play becomes exploratory. Autistic kids respond to empowerment the same way plants respond to sunlight: slowly, and then all at once. 

The One Rule: No More Self-Insults 

Kids (and adults) absorb the words they repeat about themselves. So, in my playroom, we say feelings, not identities. “I felt stupid” instead of “I am stupid.” “I felt annoying to others” instead of “I am annoying.” “I felt overwhelmed” instead of “I am too much.”  

Parents often mirror this pattern without noticing. “He’s impossible.” “She’s manipulative.”  “He’s just dramatic.” “She doesn’t care.” I gently redirect both because identity words shape how kids understand their place in the world. Autistic kids, who often face a lifetime of criticism for simply existing, need a place where their sense of self can remain intact. Correcting identity language is one of the simplest and most transformative interventions I practice. 

The “Safety Parent” 

Every autistic family I’ve worked with has a parent who feels like the “problem parent”—the one who yells, withdraws, threatens consequences, avoids conflict, or gets labeled as harsh. What I learned is that the parent who struggles most is usually the one who needs the deepest invitation into the child’s world. I bring that parent into sessions—not to supervise, but to observe attunement in action. I let them see how: 

  • slowly I talk 
  • I match the child’s breath 
  • I phrase questions with permission 
  • I wait in silence 
  • I interpret behavior as communication 
  • I anchor the room with predictability 

This is my favorite part of my work because the safety parent becomes powerful, gentle, and connected once they see their child accurately. Not through shame but through understanding. Over time, the parent becomes a co-regulator instead of a correction officer, and the child, seeing this consistently, begins to reach for them again. I’ve watched relationships that seemed broken transform into genuine companionship, not because I fixed the child, but because the parent finally had a map. 

When We Stop Treating Autism Like Defiance 

In my work with these children and their families, I’ve come to understand that therapists must know autism—not pop-psych autism, not social-media autism, not outdated autism—actual autism, and actual autism is: 

  • sensory processing differences 
  • a different communication rhythm 
  • a unique relational style 
  • a distinct way of understanding fairness and truth 
  • a predictable stress/recovery cycle 
  • and often, a trauma history from being misunderstood 

Autism is not a behavioral issue, manipulation, noncompliance, or defiance. Too many autistic kids have been placed in settings that only worsened their dysregulation. Too many have been punished for sensory overload. Too many have been misdiagnosed as oppositional, disrespectful, or personality-disordered because clinicians didn’t understand autistic communication.  

In my work with autistic clients, I’ve learned, or I should say, they’ve taught me that competence isn’t optional and that I needed to understand that stimming, masking, shutdown, overload, monotropism, sensory profiles, are the way autistic nervous systems respond to relational pressure. I’ve needed to be comfortable with silence, scripting, indirect play, rejection, honesty, rigidity, and shifting connection. And, of course, it’s been crucial for me to step away from the gravitational pull of diagnoses, because each child is unique. Kids aren’t broken. Our lens is. 

Why Parents’ Growth Heals the Child 

People think therapy “works” when the child changes. In my experience, therapy works when the parent: 

  • softens 
  • sees accurately 
  • shifts interpretation 
  • stops fearing their child 
  • recognizes their child is trying 

When the parent experiences a moment of clarity, they come to realize that maybe my child isn’t trying to hurt me. Maybe she’s trying to survive, and the entire trajectory of treatment changes. I once watched a parent who was initially rigid and overwhelmed grow into the most attuned, steady presence in the child’s life. He told me, “I didn’t realize how hard she was trying until I watched you watch her.” That’s the beauty of working with autistic families––when understanding enters the room, hope returns. 

What Autistic Kids Have Taught Me 

Autistic kids have taught me that therapy isn’t about perfect technique—it’s about presence. They’ve taught me to: 

  • move slowly 
  • assume goodness 
  • stop pathologizing difference 
  • treat autonomy as essential 
  • let the child be in charge 
  • listen beneath behavior 
  • respect sensory truth 
  • see parents as co-survivors, not antagonists 
  • hold space for relationships that need repairing, not replacing 

Most of all, autistic kids have taught me that I’m not there to fix them. I’m there to see them. I’m here to understand their internal logic. I’m here to become someone they don’t have to defend themselves against. That alone can change everything. 

I’ve seen families reconnect in ways they didn’t believe were possible. I’ve seen kids reclaim freedom inside their own bodies. I’ve seen parents rediscover the softness they thought they lost, not because anyone was broken, but because the adults finally learned to hear the story beneath the struggle.  

If I could offer one reflection to therapists who work with autistic families, it would be this: When you hear a parent say, “I can’t stand my kid,” don’t judge them. Translate it. What they usually mean is, “I’m afraid for my kid.” If we can hear the fear beneath the frustration, then therapy stops being about correcting behavior—and becomes about connection, compassion, and the possibility of healing.