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.
Thank you for sharing this vital information. I have watched clients shut down in session. I try to make space for it and explore their physical sensations. My chair is on wheels and I will be more mindful of shifting the angle as I watch my clients.
Invaluable share of therapeutic knowledge! Thank you.
Thanks for this insight. I’m going to be more aware of this.
Thanks Peter and Ruth! I definitely see how difficult it is for my clients who have unresolved shame issues, especially those clients who have had years of childhood sexual molestation and abuse, to have full eye contact with me. Having a choice of where to sit has been helpful. In a recent presentation I listened to, The therapist said that if direct eye contact is too upsetting or overstimulating for the person, see if they can tolerate looking at the tip of the nose of their therapist or partner rather than at their eyes.
I have found that sitting in a way that gives the client space and options for where to place their eyes is very encouraging for them to be able to share more. I have also found that if I greet a conversation about a client’s shame with a more serious and compassionate look on my face as opposed to an expression that almost tries to force positivity, my clients are more open with me.
I also like to have multiple seating options for clients. I’ve found clients with interpersonal trauma (and shame) often put the throw pillows on their laps, even after working with me for several months. Another thing I’ve noticed is that when some historically less emotive clients start crying, my offering tissue (which I used to see as compassionate) can unintentionally indicate to them that they should clean themselves up (and stop crying), which can add to shame. Therefore, I now leave tissue near them, but don’t offer it unless I see them looking around for it.
Handing someone a tissue can interrupt the process of their releasing emotion too. For that reason, I allow the person to cry, express emotion etc.. without trying to console them. The idea being, emotion is energy in motion and when it’s being moved and released, I don’t want to interrupt the flow.
I absolutely agree, June. ANY attention paid to those tears can shut them down instantly. Just being quietly in the room with them, on the other hand, with no apparent notice, might provide a client with the first opportunity they’ve ever had to shed tears “in public” without feeling or being outright shamed or judged for them.
I have loved and used Peter Levine and Bessel Van der Kolk for 18 years now. I integrate art and sandplay therapy, the body, role play and mindfulness. I appreciate the reminder and I agree with some comments that we offer two or more seating choices for clients. The important take away is the reminder that this shame, trauma and other emotions are held in the body and just talking about any I find does not allow the body’s expression which leads to a new way of dealing with those emotions.
Thank you Hala
Thank you!
Thanks Peter, love hearing from you.
I love the 45° placement of the chairs idea! I will be trying this with a few clients. Thank you!
Wow! Does that ever make sense – if I am in a shame mindset, I won’t feel DESERVING of a kind or friendly face. (My disclaimer, by the way; retired teacher, never professionally involved in counseling.) My intense though unofficial studies consisted mainly of scouring libraries for enlightenment about my Mom’s severe physical abuse. ( She was eventually diagnosed as bi-polar in her 80’s!) Nothing is wasted – I have been able to be helpful because of what I went through, and being online is so much easier than standing in the “stacks.” Hope to keep on learning and helping!
I love teachers. Was a school social worker for years and worked closely with them. Love your spirit. Take care of yourself
I have several teacher friends….You are a true world changer! Please know that most of the interventions that brought hope and healing to my situation were from teachers who took the extra time to speak positively into my life and circumstances. God bless you and your efforts to understand!
Can an illustration of the two chairs at a 45 degree angle be shown? I am a visual person. Lol
Interesting. Speaking as a client who deals with deep shame, I have to say I disagreed with the advice about placement of chairs. My former therapist had her chairs positioned facing at an angle, and my current therapist has chairs positioned face-to-face. My experience is that I feel much more connected and held in the space, in the directly-facing seating arrangement. I allow myself to avert my gaze when my shame is overwhelming, but making face-to-face eye contact with my therapist has been an essential part of my healing. Perhaps the best idea, as some have suggested, is to provide multiple seating options that allow the client to choose what they feel most comfortable with.
I am another client who prefers a more direct position of seating with my therapist. Perhaps my preference is related to having been in therapy before where I was able to reveal many of those shame- inducing experiences, even though we did not work through them. With this current therapist, we are gradually discussing each experience as needed. Another difference in this therapy, one day I went into a session with a list of everything I could think of that might involve shame and read him the list with some details as needed. So all of those topics were generally on the table to talk about. This approach (while questionable) allowed me the comfort of not having to speak the words for the first time at that time. My point being, perhaps those who have done some work with the shame- inducing experiences before may not have as much difficulty with direct gaze as other people discussing those topics for the first time.
Lastly, of course, the skill and sensitivity of the therapist and the strength of the therapeutic bond makes the crucial difference in whether those extremely difficult experiences and attitudes can be safely talked about. Probably more shame-inducing experiences will be encountered before we conclude. I might say that this began to occur after about 2 years of learning to trust this therapist, perhaps not possible in some situations.
I too notice the pillows in front of my clients who have a history of trauma or shame. I interpret it as them configuring their own safe space. Additionally, I try not to offer tissues when a client is tearful or crying as it can interrupt his/her process and deflect from the experience. I like to use an office chair that has wheels on it so I can adjust myself during the session if needed. I appreciate all the comments and video to provide new information I can integrate. Thank-you!
Very true. Such helpful guidance as it clarified for me why when I was recently working with a woman who has suffered multiple traumas in her life her eyes were closed for most of our session. It was actually our most productive session so far.
Thanks Peter!
M.Marino, LCSW
Thank you for sharing. My initial instinct when listening to this is that the more us as therapists are comfortable with the uncomfortable, the better the opportunity for our clients to feel that they can sit with and reveal and work through the shame. Always encourages me to work on my own self awareness.
I really love this opportunity to look at the setting in therapy and the importance to allow the client to choose. I will try it out. Thank you!
The suggestion that the brain responds differently when someone tries to reassure a person who entrapped in shame with a smile and maybe comforting words of reassurance hoping to convey the idea that this shame no longer need rest on their shoulders helps explain why the shame becomes more intense and silent phrases such as ‘if only you knew….’ drag the individual deeper into their shame and the spiral continues.
I do like the chairs where there is a option of scenery and the client is not restricted to either looking at the therapist or obviously avoiding their glance.
This is really helpful. I’m a kinesiologist, developing a protocol about shame, along with working with neurobiological aspects. this has helped me confirm how to work with clients when in shame, as I have been concerned about sending them further into the shame spiral. Much appreciated
This is very interesting when we think of the children who look away from a smiling adult, and who (if they can) hold on to someone’s hand, leg or ‘blanky’ that much tighter. Thank you for sharing this.
The positioning of the charts is a simple but excellent idea. It lets the initiative come from the client. Curious to try it.
This information about shame is a helpful new awareness for me. Fortunately my seating arrangement allows for the client to choose the chair facing me directly or at their preferred angle on the loveseat beside me surrounding a round coffee table in front. I work with many clients in treatment for trauma. On reflection I can see that they typically choose the seat next to me. Further as a person who readily smiles, this nuanced information about smiling will help me be more self-aware of when I might be smiling. Although I don’t think I smile when people are revealing serious or sensitive information, I was unaware of its possible impact. I will remain more mindful going forward.
Is there a citation available for the study mentioned?
From personal experience as a trauma victim I can see how this explains the predisposition to a serious mindset in trauma victims and, by extension, those dealing with varying degrees of shame, blame, and regret. I often felt when approached by someone who was smiling obsequiously that I was not being taken seriously. Of course, this led to thoughts of, “How dare they not see the seriousness of my son’s murder.” When someone is in stressed state, it may be difficult, if not impossible for them to interpret even a genuine smile as anything but superficial and dismissive. Smiles are the province of relaxation and safety, not the crisis response and heightened sympathetic activation. The fact that the PAG lights up in this situation instead of the pro-social PFC once again demonstrates how important autonomic balance is to human interaction. Once you prove that you are concerned enough to show you take me seriously, then we can relax and smile.
I agree with you , Bill, about smiling, I was wondering how I could put it down with words and you did it instead. It is difficult feel the genuinity in a smile, when one is sharing ones shame . It,as you mention, can be misread of course and truly be an authentic smile. Just the suggestion to give a smile does not feel right to me.
About the chairs I think it is a great idea to have two chairs to choose from. It give a sense of empowering to have a choice.
I love the idea of arranging the chairs in a way that gives them the option to face where they feel comfortable. That makes so much sense to me.
using swivel chairs can be useful to enable a patient adjust how s/he wishes to sit vis a vis the therapist
Thank you Dr. Levine. Smiling at someone who is in pain/shame strikes me as one of the more alienating and unsupportive things you could do at the start. It only deepens the isolation and doubt that you will ever be able to grasp where they are. Everything starts with listening. Wouldn’t you rather have someone who appears to be taking in what you are actually revealing, in whatever way?
It’s the willingness to really “go there” that leads to trust and healing. The need to look “nice” is basically inauthentic, distracting and more about the therapist wanting to be liked. Of course, this doesn’t mean you don’t ever smile at people or use humor, etc. when appropriate.
Fully agree Jeanette .
Thank you for voicing it so well.
Thank for this insight. I use it without understanding how impactful it may be.
I recently completed 4 years of individual therapy. The office had three chairs. My therapist had one he sat in, and I was able to choose my own from the other two. The placements of those chairs allowed me to look straight at him, or not. I often ‘escaped’ discomfort with a sideways gaze. Eventually, I learned to identify my feelings at times like that. Then I learned other ways of self-monitoring. Anyway, I used to call my aversion my “up shield” defense mechanism to protect myself from feeling more shame or pain.
Thank-you for sharing your experience as a client. My office is small and I have several seating options in an effort to remain client centered in my approach. However I also like the option of my office chair with wheels so I can make subtle shifts in my posture/physical presence by moving my chair when I think it might be therapeutic to the client.
When I was in practice, I used to ask new clients about their preference with seating …. some people like direct facing, but most prefer am indirect arrangement, in my experience/
Thank you for the thought provoking explanations! I have two simple wooden chairs at a 45 degree angle separated by a small round 30” high table up against a wall with a double window that looks out on lush nature and provides a long view. On the other side is an 8’x8’ carpet surrounded by many “props” used in Core Energetics and Bioenergetics, as well as yoga. The walls are filled with abstract art that were chosen to be either calming or having great depth. The walls are painted a soothing green-blue. The client knows s/he is free to sit, looking in any direction and can at any time stand, walk around or work with any of the props. I take my cues from what they choose and how they are using their bodies, as expressions of what they are unconsciously experiencing. I have set this up from both my training in Core Energetics, which I highly recommend, other modalities and from my own intuition. Thank you so much for layering on some validation!
By the way, the seating arrangement we use (seated in a circle) has one other aspect: The co-leaders are seated across from each other. It provides different views one leader can see more clearly some reactions from his/her viewpoint as the other can see from the opposite position.
It also provides that no participant is directly across from a leader. The participants always see the leaders at an angle.
Thank you Dr. Lavigne for another great technique for working with shame.
I work at n addiction treatment, where feelings of shame are a given. I think the concept of placing chairs at a 45 degree angle is helpful.
Hi! My name is Rebeccah. Im not a doctor- practioner- nurse- brain doctor either. Im that person with shame. And Dr.Lavine, its very hard finding a caregiver that cares enough to notice these type of issues we ( the shamed ) have.
Thank you
Hi Rebeccah,
I wonder what your experience is? – mine contrasts with Levine’s, in that when I’ve had a shame attack, I don’t look away, or have any body language at all. Instead, I instantaneously pretend its not happening. I’f I could be more authentic, that would be better.
As a blind LCSW, I listen for potential shame cues, head lowering, face turning away, etc. but have never used a two chair structure. When appropriate, I encourage clients to tell me when they are aware of doing something non-verbally that creates no sound.
Good point I had not known before.
I used to ask client dealing with shame to look at me.
Now I see that it was not helpful at all.
Thank you so very much
Like many things, it depends.
During moments of exceptionally intense shame my therapist has asked if I could look at him gently and encouragingly and when I’ve been able to glance up for a second it’s helped. But it’s also been clear that if I can’t that’s okay too.
I’m often scared that I’ll see revulsion or contempt, but when I do glance up at his request it’s compassion. I can only bear it for a fraction of a second, but then I know that he wasn’t disgusted with me. Otherwise I don’t look up just in case it is revulsion.
It can also help as “permission.” I feel unworthy. I feel like I would be doing something wrong and asking for too much if I look up. I feel shame for wanting to look up and allow myself that connection. Being asked to look up tells me that he doesn’t find the idea of eye contact /emotional intimacy with me to be too disgusting.
Beautiful analysis of shame and a therapist’s unintended contribution to a client’s experience of it. Brilliant, simple suggestion to avoid a client feeling they have no escape from intense feelings of shame in the presence of a therapist.
Dr. Levine’s method and insight I found to be very helpful. Like most therapist I am a caring person so it is easy for me to become a caregiver. What I have discovered is that if I connect emotionally with the client’s feelings of shame and affirm their reasons to feel shame, we can begin to journey together toward healing.
Very helpful. I realize I’ve had my chairs set up this way already and didn’t really know why. It’s working!
In the abuse survivor groups we do, the seating arrangement lends itself to the positioning that he mentioned. We’re arranged in a circle.
We pointedly do not try to lighten a person’s shame. We let it be and listen. We don’t pass them a tissue. We want them to be able to plumb the depths of whatever is driving it at that moment. There are times when even the co-leaders are brought to tears (we allow that to be seen by the participant). It is under control but the participant is aware that their story is important and that we are touched by it.
Particularly, most often the participants are women (rarely do we get men to join a group). And, almost always, it has been a male perpetrator. if the participant sees me, a male, with tears as she tells her story or part of her story, she finds that a very healing event.
We let them speak their shame and find that the leaders understand it and count it valuable, worthy of being heard.
I liked your comments and they were helpful but it immediately brought to mind the terms society uses. Male perpetrator – what an emotional charged term. Is it not true that many are trying to make him feel shame so that he will change his behavior? Many do feel shame but then they don’t know what to do with it, so they bury it again. How do we get society to understand that their emotionally charged words only stop people from getting the help they need rather the perpetrator is male or female? Society says with your term “we judged you” we have no compassion for you. I hope your will provide more information on helping them . Not by force or shaming them more, but helping them to find inside themselves what causes the actions. If this information is already available. please point me in the right direction
This placing the victim and the perpetrator on the same level of suffering and so on is naive and destructive. Ideas like this expose victims to more guilt (you’re making him feel bad for expressing how the violence impacted you) and greater danger when the perpetrator is viewed as another victim and not kept separate from the victim and dealt with as a criminal. A perpetrator’s issue is accepting responsibility for causing terrible harm, which they deny.
A very shallow and judgemental view seems to be expressed here, and fails to acknowledge that perpetrators are in one way or another also victims.
I’m not sure how we got onto the perpetrator. I used the illustration of the fact that 90%+ of the perpetrators are male. We do not have participants who are perpetrators. If we discover that a participant is a perpetrator, we find a counselor who is licensed to treat perpetrators and send that participant there.
I did note that, as a person who is a survivor and a male, I can play a role of providing empathy from the gender that wounded our participants.
This is helpful information. Just to be clear? Is Peter suggesting we avoid smiling (too much) with clients struggling with shame and trauma? Also, it would be helpful to see a few pictures or drawings of preferable seating arrangements. As a new Intern/Associate I work in a setting where each randomly assigned room can be quite different, so requesting a room where I can quickly make some minor adjustments before session might be best.
Jeanette – I agree that illustrations of suggested arrangements would be most helpful.
Another thought about your ‘randomly assigned rooms’ – perhaps you could ask your clients to ‘help you’ to rearrange the chairs so *they* will be comfortable?
Most helpful can be therapist modeling an attitude of calm and acceptance, shown in bodily and facial calm. That is the alternative to the disturbing arousal that the client/patient is experiencing. And the path from arousal to relative calm is the path that the patient needs to notice, practice, and be able to tread on their own.
I suppose the idea of invading the space or being invasive of their space comes to mind as I hear this. The equivalent for me of the chair position for online telephone coaching, could be energetically giving space for the client to process their pain and be sensitive to what Peter is saying is occurring in their brain. Thank you for this.
Thank you for sharing – I would like to actually see the facial/body expressions that Peter is talking about, visual insights work lasting with me.
Agreed, visuals would be extremely helpful!
In our abuse survivors groups, we need to listen to the words as well as the expressions. “I was so stupid” “I should have known better” and endless variations on those sentences are clear indications of places in their stories that are seen as full of shame.
Deep shame almost always includes not making eye contact and actually looking down.
Karin and Jeannette, agreed, though he did gesture with his hands to give a bit of a visual, at least.
I find the seating arrangement very informative and helpful. Like one comment, I do have three chairs in my counseling office. I usually sat in the chair opposite to my client. Now I know this, I will start to implement it right away. thank you very much
Seating is so important! I have a sofa for clients & my chair is at a 45 degree angle from most positions so they can choose. Thanks
So what I heard is the seating is important…why does this make a difference and how can we better support clients thru shsme?
Seating is so important. Simple yet powerful way to be with the client.
Thank you! As a Jewish chaplain relating to Jewish residents in a long term care facility, I try to meet them on their level, usually face to face, rather than standing over them. However, they are often uncomfortable and make it clear that face to face is more than they can handle. I think past shame and trauma can explain a lot of that reaction.
I found this very interesting. In my counselling room i have three chairs two are facing each other and then the third is at a 45 degree with my chair. I did not realize the significance until now.
Thank you
I plan to change my chair to an angle more conducive to helping the client have their own space.
A good reminder re staying with the emotion and the placement of chairs. Thank you