“Hi Jon. How do you differentiate shame from guilt and how do you work with a client who has suffered abuse and feels shame?” Thanks to Florence for this question which many therapist ask!

Guilt: “I hurt you and feel remorse, so I want to reach out to you to repair the damage to our relationship.”

Healthy shame: “My behavior fell short of my ideals. Shame reflects the tension between me and how I want to be. Thus, healthy shame orients back me toward my ideals.” It’s easy to forget that there is such a thing as healthy shame. But all we have to do is remember a “shameless” celebrity who acted badly. The term “shameless” is not a compliment. It reflects on the person’s failure to re-orient himself to his healthy ideals. Don’t forget, if a loved one did something bad, you would hope s/he would feel ashamed. Guilt = “I did something bad to you.” Healthy shame= “I am bad and should be better.” It’s important to remember that we have a healthy superego: the ideals, values, and morals which guide our lives.

Pathological shame, the kind of shame we most often treat in therapy, is a form of self-attack. The patient reports a feeling and then suffers a “shame-attack” which punishes the patient. I don’t think of pathological shame as a “state” but as an attack, a defense. There is nothing healthy about pathological shame; it cripples the patient. Thus, we deal with it as a form of self-attack or character defense.

Pt: “And then he began to rape me. I feel so ashamed telling you this.”

Th: “Notice how this shame attacks you right now? Do you think this shame could be making you depressed?”

Pt: “Yes.”

Th: “Could we look underneath the shame and see what the feeling is toward the rapist? If we look under the shame, what is the feeling toward him?”

As Florence points out, often, abused patients feel shame. In part, this shame is a form of self-attack. However, Nathanson and others have found another way to look at this: borrowed shame. The patient “borrows” the shame that belongs to the perpetrator: the defense of identifying with the aggressor. However, once the patient faces the rage toward the perpetrator, this defense usually falls away.

Some perpetrators project their shame into the victim, telling her that she “likes” the abuse. If she “likes” it, he need feel no guilt or shame.

Pt: “He said I liked it.”

Th: “So he not only molested your genitals; he molested your mind. He put his penis in you and then shoved his shame in too. Can we take a look at the rage toward him for doing that?”

Pt: “Maybe I did like it.”

Th: “If you did, you wouldn’t be here. He molested your mind too. So can we take a look at the rage toward him for doing that?”

In victims of abuse, shame is usually a defense against facing the massive rage toward someone the victim loved. These complex feelings of rage and love generate guilt. Unable to bear the mixed feelings, the victim protects the perpetrator by turning the rage upon herself and feeling only love toward the victimizer. Our task is to help her face not just her rage but her mixed feelings toward him.

Therapists, outraged by the abuse, often mistakenly try to help the patient face only her rage. This encourages splitting. The patient will oppose you. Instead, our task is more complex: helping her face the mixed feelings toward the person she loved and hated, the person who was kind and cruel to her. Horrified by her love for the victimizer, we act out the split by pointing out how awful he was. Instead, we need to embrace both her love and rage toward the victimizer. If we can embrace her complexity, she can do the same, and then she can cast off the mantle of shame, which has always hidden the truth: who she really is. Shame is the grimy coat that hides her essence.






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