Working with a client who struggles with deep feelings of shame can often be a delicate and nuanced process . . .
. . . and according to Peter Levine, PhD, there’s one mistake practitioners sometimes make that can send clients even further into shameful feelings.
Here, Peter will share what that mistake is – and one way to avoid making it.
Take a look – it’s about 4 minutes.
As Peter showed, when it comes to working with shame, making that minor adjustment can often be an important first step in clearing our client’s path to healing.
So I’d like to hear from you – how will you use these ideas in your work with clients?
Please leave a comment below.
Re Peter Levine’s video today and his closing observation. is it possible that when a person in a trauma state sees a smiling face that both the cortex and brain stem lights up on a fMRI if there is some cortical functioning still present and some traumatic reactivation still present. I think Van der Kolk talks about the “going off line” of parts of the brain in traumatic “falling apart”. When the patient has achieved some structural reconstruction is there not some capacity for “falling together”, my phrase, that can show up in the fMRI. Thus if with external support and the neural pathways fueled by a trustful seeking drive (Panskepp) and the reframing of the trauma into an acknowledgement of rough and tumble play gone awray (Panskepp play drive) cannot the traumatic state be relieved and eventually the healing pathways reconstructed?
Some of my clients say they prefer to call in for their sessions because they feel more comfortable to share without having to look at me. I notice the difference for when they are on the phone than in person. They open up more on the phone.
sorry, I am so shamed based listening to all this good stuff brings up the dragon…of shame
I think it’s also important to be careful about word choice. It is really easy to trigger someone by using even inocuous words, phrases, or concepts. Trauma survivors may also react negatively to material which they construe as taking power or control away from them.
Really helpful. Kindness could similar to grooming, no wonder the brain lights differently and that is the last impact I want and will add to the trauma. I heard this before and have changed my stance when working with families. And I agree with placing of chairs, I work with families in the home, so important to empower
I am a client … definitely when my first therapist smiled I was confused and afraid… I thought he might be wanting something from me… like my abuser.
Using tele health options the client has the option to not look at the screen, perhaps pointing out that this is acceptable when setting up the tele health relationship would allow for more “space”. I like the idea of rocking/gliding during a session as a grounding, soothing point.
I am curious how people are navigating with telehealth, where our faces are right there, in “eachother’s faces”! I see the posture of shame frequently in my traumatized patients, and I continue to just rock in my glider, and hold space for them. It still seems invasive to have the screen right there, “looking at them”. Any creative suggestions? Thanks!
This is a very interesting point you bring up. Would love to hear all the responses to this one.
I was wondering the same thing…. I’m going to pay more attention and see what I’m doing and get back to you. I have had clients turn the video off as a way of giving themselves that space.
As a client with shame… I like this approach very much.
This has really made me think about the way that we are currently delivering our trauma services via video consultation due to the pandemic. I think we need to think carefully about the set up of the chairs so that the patient doesn’t have to make direct eye contact if they don’t want to. It’s made me realise why one patient in particular is reacting the way she is.
Thank you for this.
After carefully listening I am still processing those extremely important informations..
Yes clients posture is very much important in my work experience and comparisons made to trauma clients absolutely valid.
Both are sinking in, trying to get smaller to the point of being invisible!!!!
But I firstly don’t have enough knowledge nor experience to take this further, because I can feel there is more to be discovered and said regarding SHAME and TRAUMA .
Therapeutic space, is part of the basics lectures when doing Postgraduate certificate in psychotherapy (Uk).
And I am so grateful for you making such a important point for sitting arrangement in the therapeutic space.,
As a practitioner that has worked with shame and trauma throughout my career I would have to say that I have seen these same results. I think it is essential to be aware of our facial expressions and body posture. I do an exercise with clients about non-verbals where we act out and talk about becoming more aware of our non-verbals (body, face etc.). It has been really helpful.
As a student with PTSD ect myself this is really important….I’m really glad its been pointed out…..last thing you want to do is make things worse!! Kindness can seem patronizing and actually ignoring/denying patients realitys in therapy because it creates more even more distance bettwen the survivor and the therapist that a happy/kind response is profoundly wrong when someone has profound sufferings…..so I can see that it could lock out the patients reality But lock in more shame-makes sense!!!
OMG,Thank you!, The way you articulated that makes so much sense to me. I often feel ashamed of my shame when someone gives me a happy/kind/bolstering response to try and turn me or someone else around! … As a coach; I have given space and step my energy back in another direction to allow someone else space just as it is. …or just breathe with myself, not trying to change anything and to let the person shift or express themselves as the director… I will now angle myself and chairs.
Yes, yes, yes.
Thank you for sharing your experience. It is very useful for me what you share
My experience with client is as peter suggests. I have my chairs at an angle because of space limitations but didn’t realize it was helping! For me personally, though, what I would like in my shame is to be accepted and have warmth and caring. In shame you feel unworthy and I want someone to help me feel worthy in the moment so I can look at myself with compassion. I guess there are individual differences.
The need to have your worthiness mirrored is so fundamental and I am also aware that my clients, while needing space often need mirroring too, to learn about their shame. I guess the chairs allows for the client to reach out, so grounding and holding receptivity and presence with an awareness that we are co-regulating is enough. If a client is frozen or freezes as a result of their shame and isn’t able to recognise that they need to reach out, then again holding presence and grounding in the transitional space helps to counteract this. I also feel like the desire to make someone feel better, can sometimes be about the intolerable feelings inside me (a counter-transference) that shame can bring up. So allowing in this space might also be a way of mirroring to the client the ability to bare and tolerate shame…..? Fascinating
I experienced firsthand the opposite reaction from the ‘eagerness’ of a mental health practitioner, (who I’ve seen on a regular bases), who chose the method of practice via showing her ‘friendliness’ and ‘happy-to-help’ while demonstrating state of her own ‘happiness and self-content’ … to my face!
And how much I wanted to be helped, (and was trying to ignore the irritation), the situation always got the best of me; the involuntarily response triggered alert and anxiety, as if I was challenged and had to perform on the level I could not deal. Each appointment made me feel bad about myself, (again), reminded me how vulnerable I have become. Each time it caused me severe physical exhaustion, (not to mention, it increased my problem with human interactions and the trust; and I still questioning these appointments, whether they did any good?!)….
Showing the relation between ‘shame’ and ‘trauma’ made a lot of sense and was very helpful, thank you for that!. Kind regards
What Peter said about the posture hit home as I have severe scoliosis. My self compassion is key as a survivor, warrior, and badass! Thanks for everything you share! I may not work any longer in a professional capacity rather a life long healer of myself! And I have a facebook page Heal Trauma with Flowers. Its important to be able to see the beauty and flowers are everywhere!
Holding the space for a person to explore how they feel is a critical element of counselling that differs it from friendship or other relationships – maintaining a non-judgemental stance is another. The seating arrangement, like all other aesthetic elements, is crucial to contributing to imbuing the setting with safety and trust where the art of non-judgemental counselling can unfold. The pain of shame and the terror of trauma are easily accessible to the person exploring their effects – every little element we can pay attention to that makes the space safer and less confronting is important. We try to ‘walk with’, so trying to ‘sit with’ by aligning the chairs at an angle speaks volumes about support and inclusion.
Yes!!!!!! As a client who is dealing with shame, this right on the money.
If the shame is a very new wound, the seating arrangement described could well facilitate a non-threatening space in which to express/divulge, or, begin to, the deeply shame-inducing experience; as could a more neutral but perhaps mild presence of the stranger who is now sitting as one’s crisis counselor when safety is of utmost importance to the client. The new, raw crisis that now gives rise to shame on top of trauma is likely very confusing to the subjected individual. It is a delicate position for both counselor and client, and incumbent on the counselor to be available yet simultaneously non-threatening. When the wound has festered for time, even years, the validation of one’s essential worth as a human being vis-a-vis the counselor’s conveyance of acceptance, compassion, and empathy is often a needed and acceptable therapeutic use of self (confirmed by several of those who posted comments). In a perfect world, would that counselors could have a sense of where a client is and what would best facilitate their healing.
Very helpful and succinct. I also (as one of the previous comments stated) had a client who for months would sit behind me and talk to my back because she didn’t want to see my facial expressions when she talked about her shame. I agree about chairs being at angles so the client has space to not have to look at the therapist should she not wish to. I also agree with what he said about trying to be kinder/more empathic to the person in the midst of their shame can go in the wrong direction. I have found that when a person is deep in shame, kindness/compassion is not trusted. The reaction can be that it alienates the client. They don’t believe in kindness, it’s unfamiliar to them and they don’t trust it. It feels oogie, like the therapist is making a bigger issue of what the client is presenting then the client wishes it to be. It’s not that we don’t want to be kind/compassionate; it’s that we want to present it in a more factual or objective way, maybe just mirroring the client’s words rather than ask them to face the enormity of the situation that caused them such shame.
Insightful advice is invaluable.
I was such a client…..that the kinder people were to me it triggered….fear…terror..and then I would experienced rage.
Thank you for that tip. Here in Belize, eye contact is very intimidating and I have had to adjust the way I practice and even the way I interact with friends and family. No matter what I am dealing with, I have my chair at an angle and still have to be cognizant of looking away from time to time. There was even a student for whom I had to give her my back and face the wall to make her comfortable enough to talk to me. This was a good reminder that it’s not only what we say to our clients, but also how we present that is important.
My therapist said after I told him about an incident where I felt a lot of shame when I made a mistake in front of a lot of people that my sensitivity around what I had experienced could also have a silver lining in that I could see myself as potentially a strongly empathetic person. I liked thinking of myself as strongly empathetic and believe that I do have that quality which I value.
I like smiling faces that make me feel comfortable and didn’t think about the possibility of my smile appearing threatening to someone who is in shame. Thank you for the insight.
I have seen what Peter talks about in my work. Do others have experiences on ways to engage a client deep in shame and catastrophizing?
Dawn O’Regan, LISW
I guess for me, the actual look on the ‘friendly face’ could make a difference – I posted earlier that I wanted to be assured that I’m a good person, and shown compassion. But maybe somehow I don’t fit into this category?
I will listen again, but I suffer a lot with what I think are feelings of shame, and feel that what I want is to be reminded that I’m a good person. What I really want is to feel loved. Is Dr. Levine suggesting that would be an inappropriate response from the therapist – to help me feel loved and supported? Maybe what I’m suffering from isn’t shame – or maybe it’s combined with other feelings?
Hi Frances,
Wanting to be loved and reminded that you are a good person makes complete sense. It sounds like you are ready and willing to accept those positive messages from a therapist. I think what Dr. Levine is referring to is more the situation where the person is so deeply in shame that they do not feel worthy of love and they deeply believe that they are not a good person because of whatever happened. With that person, to respond with kindness can feel like the therapist is being disingenuous. The person is not ready to hear the positives or see a smiling, positive face, so the therapist might be perceived as having poor insight, as if they are too dense to realize the client is a bad person (since that is how the client sees themselves). It sounds like you have shame feelings that are painful but a part of you is ready and able to hear that you are also good and loveable, so you want empathy and reinforcement because part of you knows you are worthy of both. The person he is talking about can’t yet conceive of the idea that he/she is good or lovable, so to suggest they are, might make them feel profoundly unseen and misunderstood. I hope I made sense. It is hard to type out these thoughts. Wishing you well.
This is a beautiful response for Frances and for all the others who find themselves either as a client or as a therapist. I hope she sees it.
Annette
This is fabulous, it reminds me of my grand parents who used to say always sit at 45 deg angle to make guests at ease. All makes sense now, thank you.
I can really relate and understand how seating, positioning makes a difference. Naturally I have been sort of sitting to one side at times and can feel when it feels intense. I am sensitive and often detect if it feels intense to a client. Thank you for sharing this knowledge.