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.
Peter’s comments about seating feel very accurate and helpful. I am a therapist and a trauma survivor, and I don’t agree that being compassionate makes things worse. I believe it is important to make some sort of comment about a trauma memory is necessary. It does not need to be long or effusive. I have had a therapist make no comment when I shared a painful memory, and I felt retraumatized, being alone with no indication she understood.
Thank you so much for this short but very enlighthening lesson.
I will use it with my client since shame is a very common feeling we encounter in therapy.
Michel Lemieux
Sylvia Perey other Ca.
Thank you for your service of posting small bits of informative talks. I love Peter Levine, so genuine.
I have always admired Peter’s use of brain research to inform us as to what might be going on with a patient. His idea of working with shame and changing the seating in the office is helpful and easy to put into place. Thanks.
I have a soothing picture of water and a path and flowers and often my clients focus on it instead of looking at me. This soothing picture helps them to feel safe.
Hi Ruth, thank you so much for this piece .
My personal experience is slightly different – I found the compassionate eye the most amazing way I personally overcame shame.
Hope this helps.
My regards and best wishes,
David Roy ?
yes, I sit side by side with my child, whereas others confront him face on…it doesn’t work and it continues to be done this way by professionals..This is the ride in a vehicle with someone effect…it provides everyone with an opportunity of non confined space. I will speak up about this simple and opening way of connecting to those who work with him.
Thinking about comments like how to allow averted gaze when working by video conference: my office has a window beside my computer. When I turn toward the window, I am looking past my monitor at about 45 degrees so my client is seeing the side of my face. I am still able to monitor the client’s movement and body language in my peripheral vision, but the client is freed from my face-on stare. Likewise, the client is free to look wherever, downward, out in space, etc.
I’m not a therapist but a complex (And seemingly never relenting) experiencer and so therefore yet also a researcher of trauma. I’ve always held Peter Levine’s immaculately concise mastery of trauma at the highest regard, and so I’m grateful to have just watched this clip because it’s not only given insight to a very difficult aspect – shame – but this very my h helped me to understand my shame more as “symptomatic “ and not just more shameful things deeply crested In my aching heart and bones to feel shameful over and further isolate .
Thanks for sharing this
Ashley V
Peters comment about how we even arrange our office seating is so helpful. I’ve always arranged my seating with chairs for clients at a slight angle rather then right on facing me. As a Brainspotting Therapist it’s interesting to note that clients often stare out my window where when focusing on trauma induced shame. I find at these moments it’s important to just let them either speak while averting eye gaze or just simply sit quietly and avert eye contact as I KNOW their brain is doing some inner work.
Thanks for the further validation of what’s going on when this occurs.
As parent of four traumatized kids, I’ve never seen the MRIs but he is absolutely correct. My son calls that nice face “a mask” that hides what they are really feeling. His “lizard brain” kicks right in and he doesn’t trust them at all. Other suggestions would be to place seating against a wall not in open space, let client have the seat closest to exit, and have a weighted lap blanket available to clients. You can use removable cover for washing. If you want them to talk about scary feelings you have to make them feel safe first.
Providing a client with seating closest to the exit puts the therapist in a very vulnerable positioin, so I would recommend avoiding that seating configuration….the therapist also needs a very secure “way out” for the rare time that a client is threatening.
I agree. I have had to use an exit at times. While we might both have direct lines to the exit, I am always a little closer.
Very helpful reminder for being alert to safety in the room for the client. Being careful with proximity, eye contact & what smiling might mean for them in the context.
Yes, sitting side by side or at an angle is always good. It gives both client and therapist/coach space and helps winden their ‘thinking horizon’ , a sense of choice and freedom for reflection and introspection. Very important.
I work more with kids and young adults and often times have coloring or doodle paper on the table with two chairs. There is something that happens when they are able to do something else and look up as needed. Sometimes it starts out with a few moments of coloring and then the client will just put the markers down and talk easily. Sometimes I have had clients that are drawing what we are talking about – like an infographic or wordle – and these have been quit amazing. I also have a parent group that gets together after work and they love the coloring while they talk. They say it is relaxing and allows them to enter into the conversation in a non-threatening way.
I plan to move my file cabinet and office chair to a slightly different angle, it’s been on my mind to do this for awhile now. Thanks.
Thank you.This is most helpful. I shall try rearranging my chairs.
Help iam in deep hot water
Thank you Peter for making the connection between a posture in shame and in trauma. I often realize that little actions like the positioning of the chairs help our clients a lot to regain a room for self steering.
I think seating arrangement is important as a consumer. From my perspective, the first visit can tell a lot about how things are going to go. If a therapist is sitting at a desk, they should move away from the desk during therapy. They need to remove the authoritarian symbol from the session and sit one on one with the client. I like the style of Carl Roger’s when working with trauma and shame.
I seem to recall debra Lee saying something similar. Anyway, if shame has its roots in our evolutionary history of being expelled from the clan or group, then yes, I can see that being expelled from a friendly group would be even more traumatic.
I much appreciate Peter’s recommendation and many of the comments I’ve read here; really helpful insights.
Can you folks recommend some reading / Titles on the topic of Shame / Treating Shame that you’ve found especially helpful?
I use this principle by putting the chaires on a way, there is a way out in eye contact, a 45 degree angle
Very concise concept to assist people working through shame.
I have noticed that direct eye contact can be threatening and make the client recoils in his world. In these situations allowing the client to find his own space by positioning myself way from his gaze has been very helpful.
I agree with the others… there isn’t a clear alternative presented, other than using 2 chairs at a 45 degree angle. It seems that if therapists are to avoid trying to make clients feel better, then the alternative would be simply acceptance and non-reactivity. But exactly how do you work with this in a session, especially if the session is via Skype/Zoom/video conference (or phone)?
The idea of sitting at an angle from cliens was offered to me by James Bugental PhD. While my office is set up with me at a 90 degree angle from my clients I can swivel my chair. I try to be careful and caring when choosing the direction of my interactions.
Thomas Shaker, MS. L.L.P
Peter makes an excellent point. According to the Affect-Script Psychology of Dr. Silvan S.Tomkins, as well as Dr. Stephen Porges’ Polyvagal theory, shame is produced by the interruption of the pleasurable affects of Interest-Excitement or Enjoyment-Joy. This interruption produces the automatic physiological response of “collapse”/ shut down and interpersonal disconnection or what I refer to as “deflation”. This CNS, sympathetic, autonomic reaction is best explained as the dorsal vagal response, which, in its extreme state produces fainting & loss of consciousness. In a traumatic event when fight or flight are not possible responses, which would engage the ventral vagal branch of the Polyvagal nerve, the FREEZE response occurs. This is the shame / collapse experience. The client’s neocortex, cognitive faculty interprets this as cowardice and weakness for their failure to run or fight, thus compounding the feeling of shame, inferiority & inadequacy. I educate my clients with this explanation to help them understand that their body automatically chose one of the three survival mechanisms, without their conscious consent and the fact that they are speaking to me now, about it, means they successfully survived and their negative judgments are misplaced & incorrect. I don’t try to soothe or comfort them as this information has its own power to do that.
I appreciate your response as I take a similar approach. I primarily work with trauma, both combat and sexual, and have found my clients experience relief and a reduction of shame when they understand this concept as being autonomic.
Re-spect means that there is somebody looking back at you; there is a relationship. In shame that relationship is broken, first by shattering the client’s internal self-relationship with the usual regressive responses including collapsed posture. I loved Peter’s suggestion for placement of the chairs. This is one time to NOT look at a client at all unless they choose to reach out. Many cannot. At that moment I would respond by simply labelling what is happening: “I see, this is some acute shame. So you feel you want to hide. That’s fine.” If the client had been prepared ahead of time with rebalancing strategies, I would ask what they need to do right now to get back in balance. If not I would just sit quietly and suggest that they simply begin to observe the sensation of breath in their nostrils which is both relaxing and grounding until they are in a position to do or ask for more.
Gwendolyn Aldo below makes a very good point about cultural nuances in both the triggering and the expression of shame, especially in Asian cultures. Here a bit of cultural savvy could be critical, whether it comes from formal training or just from having gotten to know the world.
I will wait for the moment to pass I will not try to fix
Interesting as this supports a piece I had published this past month titled The Ill Timing of Empathy when Treating Trauma posted in the National Psychologist. good to know. thank you
It’s interesting to know that shame and trauma have some connections and working with clients to make sure there is the distance they need and why. Love the studies!
I found this extremely frustrating. Can you please summarize this in three sentences. Smiley nice makes trauam/shame patients feel fear. That makes sense— groom the victim– happy faces are associated with seduction/ being victimized. Is that the point. What’s the alternative/antidote?
thank you.
I have the same experience as Marian. What is the way that would be helpful to look at the client–facial expressions other than smiling, which from Peter Levine’s lecture, makes things worse.
Thank you.
On this thread I’d like to comment as a survivor. For years, I was unable to make eye contact with anyone, other than very briefly. Much of the shaming in my life came first from my mother, then from music lessons where the teacher was always positioned at the side, then from several sexual assaults and a violent husband. In social or workplace contexts, a person who doesn’t make eye contact is viewed as deceptive. I had to learn to force myself to make some eye contact, in order to succeed in life. From doing that, I was able to observe and learn a lot about the world around me. Much later in life, I had a couple of unfortunate sessions with a therapist who insisted on close proximity and nearly continuous direct eye contact. I gave her several reasons why this was not helpful, but she persisted. I left. Now, at age 71, I realize what a privilege it has been that I myself have had opportunities to support traumatized persons in two situations: persons with HIV/AIDS during the 1980’s and 90’s, and three different men with dissociative personality disorder from extensive childhood trauma that included torture. Two things have helped in both situations. One is the idea if pacing the emotions or postures of the person I am supporting. Second, realizing and articulating repeatedly that this person has already survived. When a person is more recovered, telling them repeatedly that they are not what happened to them, but a survivor who is a unique and remarkable person, seems to support the later stages of recovery.
Really interesting. I know from my own therapy training one day working in a small (and very familiar to me) group. I felt I had failed badly at an exercise which brought up feelings of shame and self criticism. I was curled up on the floor in a blanket with my eyes shut. The group facilitator encouraged me gently to open my eyes and look around the group. As i looked into all their eyes one by one I saw kindness and compassion and felt accepted rather than ashamed. Shame puts us into a place of retreat, hiding and disconnection. While I feel connection with others heals shame. I guess as a therapist it’s knowing when to encourage connection e.g. making eye contact, against when to hold off from that because it’s more shaming. I know it took me about 4 years with my therapist before I could make sustained eye contact with her. It felt very difficult like I was being revealed…and shame made me want to hide. But once I was able to look deeply into her eyes it felt like a real breakthrough, like I had nothing to be ashamed of but was worthy to truly meet a person I respected so much.
Proximity is a powerful aspect of attachment therapy of which the feeling of shame is ever present. Thanks for the reminder.
so useful…so cutting edge….so practical….thank you, ruth b and staff plus peter
Thank you for making this available. I am not a counselor or therapist by education but have worked with horses for the past 25 years and have invited people who are overcoming trauma/shame to watch. It is amazing how in watching the horses and relating to the flight, fight and freeze response that horses exhibit when facing a fear or challenge that people feel released to share their pain. It seems, like when the pressure is off of them directly and the focus is on the horse, their defenses get lowered. Could this be similar to what you are explaining?
I love that you bring up horses – I was going to make a comment about them related to Peter’s mention of how the therapist and client are facing each other, while you brought up a different aspect re horses in equine therapy that also relates. The horse is a prey animal and a herd animal, so they tend to be hypervigilant, especially if not with their herd or troop. Human beings are also social animals, and if they have experienced stressful or traumatic events, may become hypervigilant and easily triggered. Re your observation that clients relax when working with horses, it is due in part to the focal change, but also because the horse senses somewhat of a kindred soul, so to speak, and a special dynamic occurs between the horse and person – the “I and Thou” almost spiritual reverential relationship Martin Buber discovered. The person makes a connection with the horse, much like a client develops a relationship with a trusted therapist.
My comment relates to Peter’s mention of how a client and therapist face one another: in approaching a horse, a 45 degree angle is the least triggering for the horse, what feels safest for the horse (because they have a blind spot if something is directly in front of them, and will have to move their head back and forth to keep an eye on the potential predator). Removing that stress, they are less hypervigilant. I find that with clients with shame or trauma, arranging furniture so there is an option of angled seating (vs. full frontal, knee to knee interaction that can feel more confrontation) is best. It is a more trauma-informed approach, allowing a sense of safety in a spatial way in the room – just like the angle with a horse.
Thank you for this! I am a student wrapping up my Bachelors and preparing to get my PsyD in Psychology. I’m also in counseling. My counselor sits off to the side of the room in session which allows me the choice of making eye-contact or looking elsewhere in the room. Sometimes I want and need the eye-contact, more often than not, it still makes me uncomfortable. I never understood why I had the feeling of discomfort until now since I ordinarily value eye-contact but do not usually discuss the trauma and shame that I am dealing with in my sessions. Interestingly, the times I have needed my counselor to help me ground and come back to present because I was unable to engage in the process myself beyond hearing what he was saying, he positioned his chair directly in front of me and very gently but firmly continued to draw my attention back to making eye contact with him. When I was grounded, he resumed his regular off to the side position.
I had never considered where the client sat versus the counselor significant until the first time he made that change. It made all the difference for me, and I realized where he sat had been making a difference all along. It is something I’ve noted in my “Things to Remember” notebook for my own practice and now I have a better understanding of why it has been so important for me. Thank you again!
I use a version of this way Peter works. If a client is wanting to tell me something that is extremely shameful for them, I ask them if it would help them if I sat beside them instead of facing them. They always say yes to this. I check that I have not placed my chair too close, but always make sure I’m also not too far away. This seems to help them.
I agree with just asking the consumer/client what they feel comfortable with as if you are guessing, you may guess wrong. I as a client always prefer eye contact. Make sure you ask. There will always be some discomfort and that discomfort sometimes helps the client to talk because they are trying to fill the moments of silence. Also a therapist can always look down or move there eyes off the client. But asking first is better.
I use a version of this way Peter works. If a client is wanting to tell me something that is extremely shameful for them, I ask them if it would help them if I sat beside them instead of facing them. They always say yes to this. I check that I am not sitting too close, but always make sure I’m also not too far away. This seems to help them.
A fascinating observation
Thanks so much! I will be using this info on clients who belong to the population I researched entitled “Lives Unseen: Unacknowledged Trauma of Non-Disordered, Competent Adult Children of Parents with a Severe Mental Illness” freely available at The University of Melbourne, Australia. This research will come up if you google my name, along with some trauma-informed articles I’ve posted on medium.com (includes a recent one on “Shame”). You should also be able to access my resource website same way. (Hope this is helpful). Thank you!
Suzette, thank you for posting the information about your own work. I am an ACOPSMI (paranoid schizophrenia) and it has often been impossible to find anyone who understands what a devastating effect that has on a child. I still work with the damage that was done.
Also, in addition to working with the positioning of chairs at an angle, I would also strongly urge therapists to research distance. I once had a therapist who insisted on sitting 8 feet from me. I was unable to work with her because the social distance was too great for me to comfortably share anything with her. I feel the maximum distance should be 4 feet (far enough that the patient/client can’t kick the therapist!) .
Susan, I am a grown child of a mother who has paranoid schizophrenia. I want you to know I can decipher my mother’s illness from her soul and heart, and despite any behaviors of hers I never doubted her love for me. She was always as honest as possible with me also. That is what has made me strong.
Thank you for sharing this important aspect! I noticed that some clients react with rapid eye movement when sitting in front of me, while giving them space and a different ancle in sitting reduces this symptom
Small changes; potentially large outcomes! Its handy to be taken back to the fundamentals of training in counselling skills — and the design of he counselling space.
Love this!
bloxorz is a spam advert for an online game and games website.
Total time waster although its true it might keep some people from worse ways of spending their time…..
Thank you for your amazing comments regarding the alignment of trauma and shame and how they look in a collapsed body.
I am using Clinical Hypnosis in my practice. This works to open up the release of shame within the unconscious mind. I then work with the body, through, hypnosis, to realign unconditional love (which is not performance based) for one’s body, replacing shame with love and gratitude for self.
THis is really really helpful, I was in a situation where I inadvertently caused shame in a part time work colleague, whilst trying to be honest open truthful transparen non harming! This is the missing link of a jigsaw, which without it was inducing, huge shame/confusion/sense of injustice/anger/sadness in me and subsequently massive c ptsd symptoms which I suffer from daily. Interestingly too inflammation levels are soaring my body and stomach feels like it is on fire. Your work is SO SO VALUABLE – THANK YOU SO SO MUCH, my life is often overtaken by symptoms and I don’t recognise my old self anymore.
If you can recommend a way to get regular affordable consistent help and support please advise as my symptoms severely impact my ability to work, even part time volunteer work.
I So need more help! And can feel it’s never ending.
Best wishes and thank you,
Emma
A Healthy Hope – Integrated Care
carolmanychief@live.ca 4033175703 We give women the SASS-Suicide AwarenessStrengths and Strategies – to kick life’s ASS-Altering Stuck States c.
I’m reminded that being “compassionate” with a client, can come across as trying to “fix” them. Which can be seen as them not being ok where they are. Hence increasing shame.
In the same way mindfulness can give a meta-awareness experience that helps us get out of ourselves, I believe we can create an external meta experience for our clients by simply bearing witness. They get to be seen and heard without judgment or expectation for change. This might allow a level of acceptance, which is the opposite almost of shame.
Thanks Tim this is very helpful, Emma
Thanks Tim, a helpful observation. Steve
thank you, a very helpful point. i practice co-counselling which has a big emphasis on witnessing, it reminds me of the power of that technique
I have never heard this before but will make this adjustment and see what different response I might get.
I don’t have any sound coming from my laptop, will you please write and tell me the “one mistake that can heighten a client’s shame”? Thank you!!!!
Unwanted eye contact can cause a client feeling shame to further intensify feelings and possibly shut down. Arrange seating so client has a choice. Place chairs
at a 45 degree angle rather than face to face to give client a choice regarding eye contact.
Very brief summary – other comments explain details.