Helping Trauma Patients Shed Feelings of Shame

For someone who’s experienced trauma, feelings of shame often remain long after the painful event.

So how can practitioners help clients begin to reclaim a sense of self-worth?

How can practitioners help trauma patients reclaim a sense of self-worth? Click To Tweet

Kerstin Jung, PhD and Regina Steil, PsyD, at Goethe University Frankfurt, in Frankfurt, Germany, wanted to find out whether Cognitive Restructuring and Imagery Modification (CRIM) could empower adult survivors of childhood sexual abuse to move beyond feelings of shame associated with trauma.

Depressed Tenage Girl
CRIM is designed to help patients do two things: change the way they see themselves (Cognitive Restructuring), and change the imagery they associate with their trauma (Imagery Modification).

To test the CRIM method, Dr. Jung recruited 34 women who suffered from PTSD as a result of a childhood sexual assault, and who self-identified with the “feeling of being contaminated” (the phrase Jung used to describe shame associated with trauma).

Next she randomly assigned them to the experimental group or a waitlist control. The experimental group took part in CRIM, a two-session treatment, lasting 90 and 50 minutes.

The patient begins by discussing the feeling of contamination – what that means and whether it is something they experience physically, or just perceive in their mind.

Next the patient is asked to use the internet to research the life cycle of their skin cells. The idea here is that when patients discover it takes about 4-6 weeks for their body to replace all their skin cells, they will realize their body is no longer physically contaminated by their trauma.

Researchers then guide participants through a visualization of their body renewing its cells in order to cement their understanding.
Meditation and Spiritual Healing
The final step in CRIM involves asking participants to activate the feeling of being contaminated and allowing any associated imagery to come to mind. They are then taught to replace those thoughts with the images of renewal they just learned.

So what did Jung and Steil discover?

The women in the CRIM group showed significantly greater improvement in overcoming feelings of shame and contamination than did those in the control group. What’s more, the treatment had significant impact on PTSD symptomatology.

Now we do need to keep in mind that this study focused on a small sample size of people who suffered trauma of a specific nature. And its waitlist control design doesn’t account for other factors that may have helped to reduce subjects’ shameful feelings.

I’d be interested to see what future studies might tell us about the impact this intervention could have on PTSD symptoms related to other types of trauma as well.

And if you’d like to know more about the study, it was published online by Psychotherapy and Psychosomatics in May, 2013. It was also published in the June, 2013 issue of that same journal.

How have you helped trauma patients deal with feelings of contamination or shame? Please share your experience in the comment section below.

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42 Comments

  1. I have used the V.K. dissociation technique very successfully to dissolve away all emotions and feelings associated with traumatic experiences. I have used this on all types of traumatic experiences.

    In addition I have developed a new hypnotic technique that identified the core elements of anxieties, OCD, Fears, Phobias etc., and while using this technique. the client’s issues / disorders are simply dissolved away (not to return). This occurs in one session. Very few clients require a second session. While this may see hard to believe it is factual.

  2. I work wirh a Music technique that allows us to tap into our resources through relig Music technique that allows us to tap into our resources through imagery. It’s cal GIM. the images transformed by themselves. We do not need to replace images. The healing it’s all within the client. New images associated with healing will come naturally.

  3. elena says:

    So the 4-6 weeks is a good turn-over speed to decontaminate. Then there is the microchimerism! Supposedly this sperm mass is also gone after 7 years. What then about identification with the perpetrator…that’s like a boomerang that keeps on returning because it’s implicit, if episodes were early-enough. You are what was done to you.

    • Joyce, SE, NARM and Hypnotherapy Practitioner, Switzerland says:

      Hi Elena
      I don’t agree that “you are what was done to you”. This would mean that we are victims of our past, which I don’t believe. I am convinced that how we now deal with what happened to us in the past causes the pain.
      I think pointing out that a persons cells regenerate after a certain length of time can be very helpful to a person who had been sexually abused. I’ve had clients who felt extremely “dirty” and shame themselves for it. I’ve utilized various ideas to help them work with the shame and “dirty” feelings. I’m definitely going to add this one to the list.

  4. Cai Carvalhaes, MSW student/AR, USA says:

    Where can I find this research paper to read.
    Thank you,

    • Nancy, NICABM Staff says:

      Hi Cai,

      You can find the abstract of the study in Volume 82, number 4 of the Journal of Psychotherapy and Psychosomatics here: https://www.karger.com/Journal/Home/223864. The full version of the study is available for purchase and download.

  5. Paul Counselling Therapist says:

    About 30 years ago i assisted a female who was poorly abused as a child; who after therapy disclosed that she had deep visions and feelings of an ugly coat of darkness, ugliness and filth draped over her shoulders that made her feel unclean and very different to others.

    Through hypnosis i took her on a journey by boat to an island and encouraged her to remove the coat and to burn it there and finally return to safe clean shores.

    She was ever so grateful of having finally lifted a debilitating feeling since childhood

    • Cai Carvalhaes, MSW student/AR, USA says:

      Paul, could you recommend a training for hypnosis for me?
      Thank you,

      • Cai, next Spring Bill O’Hanlon will be having an on-line training in hypnosis. He’s a world-class expert on it. I’ll try to send out an announcement on it. Ruth

  6. Lynn, LCSW, Chicago says:

    Whenever we commit to paying attention and actively changing our perception on a regular basis, change will happen. The question is, how to support people’s motivation to do just that. This study will help. Thank you!

  7. Laura Taylor says:

    Yes, I have helped clients overcome feelings of shame after resolving trauma. The practice of TIR trauma incident resolution is powerful, I think the hang over feelings are less than in some other models. What some of my clients face is old habits, and some of the habits are associated with old states of mind.

    REM has helped some also. To work eliminating triggers that are lower level, but can work into these old issues I use Steven Stossny’s “”heals” exercise. alll seem helpful, but always good to learn new techniques. Thank you!

  8. Sheila, psychotherapist, Montana says:

    I have had some great success with a revisioning of self accompanied by EMDR!

  9. Francis X. Perlmutter St Paul MN says:

    I’m a flaky self-employed life coach – I took one of my clients to Party City & bought him a small rubber finger puppet (just a head of something monsterish) and asked him to put it on his finger & voice the comments his ‘nice’ parents might make about a situation or… whatever. Didn’t work, either because he wasn’t too imaginative, or maybe he was uncomfortable doing anything which could be considered ‘inappropriate’ for a successful professional. Just wouldn’t do it. He didn’t hit me, though, when I wore the puppet & made comments about things being too ‘Better Homes & Gardens’ perfect.

  10. Robert says:

    Any suggestions of how to deal what they refer to us toxic shame? Every little mistake, or where I think I might look bad no matter how minor causes me overwhelming shame. It comes to me just as the physical sensations without things I say to myself at the time. It’s not very specific but seems to target just about everything broadly. I don’t recall specifically how I learned this. I experimented for about a week with telling myself every-time I had the physical sensations of shame a encouraging or opposite statement of what the feeling may be saying. For example “I did my best”, “they appreciate what I did”. After one week of this, last night I had a nightmare of a made up scenario where lots of people were shaming me which is not a normal occurrence for me.

    • Ann D. Minch, LCSW Louisville KY says:

      Robert,

      Check out Internal Family Systems (a parts model for working with internal parts, which you’re already describing. Yes they can be “body sensations”) Best way to find a therapist with expertise in the IFS model is on the website “Center for Self-Leadership”. Then look for tab on “finding an IFS therapist”

      I’ve been using this model with clients who have past trauma for about 5 years, with great success!

      Ann Minch, LCSW

    • Anne, Trauma Survivor Group Facilitator says:

      Robert,
      You might want to check out Janina Fisher’s work on Shame. She identifies it as being a survival strategy. Its purpose is to protect you from further harm, that standing up for yourself (when you’re too young or unequipped to defend yourself) would bring down on you when you’re overpowered. Rather than trying to argue with it or overcome it, perhaps, try to figure out how it’s trying to protect you so you can redirect it?

      Also, (this is a bit triggering for some survivors, and may not apply to you, so if you find this triggering don’t read these sources): if you look at the two twin concepts of “Revictimization” (from criminology) and ‘Victim Selection’ (Greyson/Stein, also Dr. Angela Book, and many martial arts/police blogs), depending on your history you may find some of the answers to how you started to feel that way.

      ReVictimization: ‘Victim Studies’ (Criminology) tells us that any victim of crime is statistically more likely to be victimized again – often repeatedly – and this is true for all types from crime from robbery, burglary, fraud, harassment, assault, and sexual assault. There are several reasons for this, and several factors involved. One of those would be victim selection. Certain victims are victimized repeatedly, while some people are never victimized at all – the risk per population isn’t evenly distributed.

      Victim Selection: offenders look for specific characteristics in victims, which many victims unknowingly ‘broadcast’. Repeated experiences of victimization, without awareness of this influence, can make victims feel that it’s their fault, and because of who they inherently are. The good news is that victims can be trained to be aware of and change these behaviours/habits, as well as being taught how to *properly* assess danger in their environment and what to do about it.

      If you’ve had mobbing or group shaming (if your nightmare represented real life experience) the effects can be much worse, especially if there was no-one to go to for help when it happened in real life. Also, some families (some unintentionally, some intentionally) raise their children to display victim/vulnerability behaviours, which greatly increases the likelihood they’ll be targeted.

      The good news is that there are a lot of things you can do to change this. The first is to be aware that you are missing self-defence skills. The other benefit is that the better you become at spotting potential abusers, the better you also become at identifying good people who can help you in times of need.

      • Robert says:

        I see she has seminars for therapists around this from some digging around. Do you know any resources for someone who isn’t in the helping field other than trying to help themselves? :)

        I was actually feeling some relief from what I was doing at least in the moment, though the nightmare was making me wonder if it was going to help long term, or not. I understand the part about victim selection it probably was why I was bullied so much as a child as I learned to not be able to defend myself and feel shame. That was the most effect technique I had at the time against a bullying father, but not something that works well in other situations.

        • Anne, Trauma Survivor Group Facilitator says:

          Robert,
          Don’t know if any of this will help but here are a few alternate resources you might want to check out.

          For instance, Darlene Ouimet’s blog (highly recommended for survivors). This article sounds like it might fit your nightmare; its perhaps an early message that you have taken on board and your body is now replicating for you (conditioned physical trauma response, not ‘irrational thoughts’): emergingfrombroken.com/when-people-treat-you-like-you-are-crazy-stupid-or-frustrating/

          Here are some sources for understanding Victim Selection and also detecting predators (although they are from a more martial arts perspective so are a bit challenging for some survivors):
          protectivestrategies.com/awareness.html
          protectivestrategies.com/victim-selection.html

          Here is an article about ‘The Criminal Interview’: how criminals test you to find out if you’re an easy, or preferred, victim: nononsenseselfdefense.com/interview.htm

          These guys have trained police and prison guards, so they talk about the more extreme aspects of violence, but I’ve found these principles to have provided THE MOST HEALING in my own process, as they apply not only to any kind of violent, boundary crossing, but also to pretty much any kind of attempted interpersonal domination/dehumanization.

          I also wonder if you are partly struggling with an engrained freeze response as a habit. If so, this author (I think he’s great, but not everyone’s cup of tea) has a whole series on ‘breaking the freeze’ (also read Amanda Ripley who writes about surviving disasters, for some more info):
          chirontraining.blogspot.ca/2007/09/more-on-heart-and-freezing.html
          chirontraining.blogspot.ca/2009/03/fifth-circle.html

          BTW, Janina Fisher DVDs etc. are entire suitable for non-professionals. Several members of my group attended one of her training sessions and it was fabulous.

          Your nightmare, btw, might possibly be trying to tell you that what you are doing works for when you are amongst decent, caring people (which is wonderful), but perhaps will not protect you if a predator enters the mix and targets you – and given your history there is a genuine risk that you will be targeted where other aren’t and these responses might make things worse. For that you need other techniques which are easy and VERY EFFECTIVE to learn to assess danger early, avoid trouble at the earliest opportunity, how and when to flee, which means in most cases you’ll never have to fight.

          There is another source you might want to look at, when it comes to identification/self-protection of emotional abuse and ostracism: I highly recommend George K. Simon’s “In Sheep’s Clothing: Understanding and Dealing with Manipulative People”.

          Best of luck, Robert. Listen to your guts, and start to commit to never letting anyone disrespect you from now on. Not easy to do if you’ve been taught the opposite, but once you get the basics it can turn around surprisingly quickly!

          If you combine any of the sources above with the concepts in the OP, cell regeneration means that you can change all of this quicker than you might imagine – as long as you’ve got the right concepts.

          This is not your fault, only that you’ve been denied learning the skills you need to defend yourself in social situations. Once you do, you’ll find the targeting will cease, except in those areas where you need some work. But even in those, you’ll spot it earlier – which is empowering and rewarding!

    • Tamara, Student, Canada says:

      Robert, I’m going out on a limb here as I am not a practitioner in any way, just someone learning and living and working on healing, too. I didn’t even know I *had* shame until recently, I’d done such a good job of pushing it away. Realizing there’s shame comes first, so you’re there. What helped me was befriending the shame, listening to what it had to say (even though it hurts and is very uncomfortable) — recognizing that the shame belonged (in my case) to a little child inside me. So I gave the shame what I would give to a child — comfort, acknowledgement, witnessing, validation. Hand over heart, I would breathe deeply and say things like, “I’m so sorry that happened to you. I know. I see what you went through, how hard that was for you. It’s valid for you to feel this way, of course it feels terrible, this is so hard, you’ve been so brave, you’ve done your very best, while you’ve been carrying all this hurt inside you, I know what you’ve been through, it’s real, it happened, it counts, it matters. You matter. I’m so sorry, you didn’t deserve that, it wasn’t your fault, you deserve to be loved and supported, I love you and support you….” etc., on and on. Basically, giving those feelings of shame lots of love and attention and kind messages. I found out I knew exactly what I needed to hear and could say it to myself. Who would know better? Just replacing shame feelings without having them heard and acknowledged and validated and witnessed didn’t work for me. The shame needs comfort and listening and love, in my experience. Then it calms down and the healing begins…(repeat as necessary, of course!) We heal when we are heard and validated, and fortunately we can give that to ourselves, as well as receive it from others. So…just putting this out there for your consideration. Take or toss, of course. Wishing you all the best.

      • Herbert, Psychiatrist and Psychotherapist, Winterthur, Switzerland says:

        That is beautiful Tamara!
        Heartwarming words.

      • Helen martin, Bowen therapist says:

        Thank you Tamara for that. Brilliant approach with kindness and compassion. Robert, I can recommend to you a book – the Endorphin Effect by William Bloom that I think you will find useful as it has all of this nurturing, compassionate approach that we can give to ourselves where we are still hurting from past experiences. I have done trainings with William and he has many years experience and recommendations eg. Carolyn Myss etc.

      • Robert says:

        Was there a particular resource you used such as a book that goes into more detail?

        I find it hard to know how to go about it in a very specific manner. That kind of language sounds appropriate to address specific instances where people did something that caused you to feel shame. Are you going back to memories of people shaming you and then doing as you described?

        Or did you try to deal with how it would show up in the now. For instance feeling shame when I made a typo in an email I sent. Or feeling shame when I recalled a conversation I had earlier where I accidentally told them something that was incorrect. When it happens now for the most part nobody did anything to shame me other than my automatic internal reactions to these kinds of things.

      • Kirsten Kraus, Somatic Trauma Therapist says:

        Hi Tamara,
        I work with my clients in a similar way. That is great you have had success in using this imagery and validation for yourself! I also feel it is important to know that shame is something put upon us by others. It just feels like it belongs to the little girl but it is not hers to keep forever. The work you did allows the activation to lower and become more “the truth of your life” without the level of activation you previously felt. I use The Comprehensive Resource Model which builds a scaffold of resourcing in the neurophysiology to safely and effectively release traumatic material. This is done along with breath work, bilateral sound, imagery, and attachment work.
        Kirsten Kraus :))
        kirstenkraus.com

      • Anne, Trauma Survivor Group Facilitator says:

        Wonderful reply, Tamara!

  11. Kristina Cizmar, The Shame Lady, Boulder, CO says:

    We talk about complex trauma – there is also complex shame. I have successfully worked with the “I am dirty” complex shame using a combination of embodied approach and a tool I developed called the Shame Translator. You’re welcome to try it for free theshamelady.com/bookbonus

  12. Phebe Fletcher MFT intern Berkeley CA says:

    I have used this ever since processing with my therapist my incest as a 4 yr old -now I share it with clients:

    1) When a client 1st shares the distress, we name the shame. 2) We identify when the ‘nasty surprise’ was felt in the story. This is the trigger, and we name it, with the client’s languaging of it. 3) Then continuing, I ask them to bring themselves back into their original innocent intention, before the shame happened.

    -Surprisingly, clients following these simple steps are unhooked off the grip of the shame affect, its illusory distortion becomes immediately apparent and there is visible release from the shame. It becomes their own tool: clients are then motivated to use these steps whenever they are triggered. It can get automatic, I personally do it whenever there isn’t anything to more to glean from an incident. This tool is derived from Affect Theory – Silvan Tompkins’ research, elucidated in Donald Nathanson’s very readable bk Shame and Pride.

    This simple tool has been easily accessible, empowering and freeing for many… fascinating to use and engage this way

  13. Linda Peterson, PhD Medical Psychologist says:

    thank you so much !! This is a wonderful and simple new approach I will immediately use in my practice.
    I think how the client works with this may take a few sessions, but the cognitive restructuring is excellent.

  14. Jacqueline Danielson, RN, LMFT, USA says:

    Sounds good, but difficult for me to truly buy, since shame is held so deeply in the body. I do see how it would help with separating then from now, which is essential. Thank you.

  15. Magda McQueen, novelist, UK says:

    The process of replacing thoughts sounds a lot like the Memory Reconsolidation part of The ICE Method (Identify, Calm, Exchange) used by Lars Clausen for fibromyalgia patients, trauma survivors, athletes and more…

  16. Karen,CH, CHMRP, Mississippi says:

    Check out healing dimensions.com for a client- centered, body-centered approach to healing from shame. Very powerful!

  17. Lori Olsen LPC, Mesa, Arizona says:

    For many of my clients with trauma, one big source of the shame comes from having frozen (or not fighting or running away or telling about) during the abuse. A thorough understanding of the threat response system and the instinctual/involuntary nature of that system, really seems to reduce s lot
    Of shame. And I do appreciate the exercise you shared above because it addresses what I have seen as the second biggest source of shame in sexual assault survivors. Thank you!

  18. Eileen , social worker , New York says:

    Could this be used for domestic violence survivors?

  19. Katherine says:

    Thanks, Ruth!

    I have a brother and sister in their late 60s who were abused by their father starting very early.
    I’ve used the Visual – Kinethestic Dissociation method from NLP with great success with the sister.

    I’m looking forward to working with this concept to help her get this past energy out of her body.

    Great idea.

    Katherine

    • Anne, Trauma Survivor Group Facilitator says:

      Thank you for posting that. The immediate question that came to mind when I read Ruth’s post was whether or not (or how well) this would work for male SA survivors, for whom shame, imo, seems to be more, and more deeply, entrenched than in females – so much so that they often can’t even name their abuse.

      So I find it interesting that you mention that your approach worked on the sister, but I presume not so well on the brother?

      If you ever get back to reading this, I’d be interested to hear what differences between them, and their response to this approach, you found.

      For anyone who treats both men and women, I’d love to hear your thoughts re: how well this might work for males, and if you think it needs any tweaking to use for them.

  20. Maedine Yee, LCSW-R, NY says:

    How does one transfer the study’S findings to burn survivors whose skin, when renewed, is visually the same as prior?

    • Anne, Trauma Survivor Group Facilitator says:

      I also have a similar puzzle; survivors of child abuse whose families still continue to slander, stalk, and harass them well into adulthood, even after estrangement? (We have a fair number of those in our group.) Those survivors feel ‘marked’ and contaminated, because in many cases they have been marked, and they are portrayed on an ongoing basis by their abusers as being contaminated. When parents continue this with no intervention, and even sometimes support from other family members, it’s almost impossible for those survivors to feel that they’ve ‘renewed’ themselves out of contamination, when the abuse continues even after their ‘cells’ have regenerated. Often for the abusers lifetime, and even beyond (through wills, setting up other family members to continue the harassment, etc…)

      This is especially true for one survivor who suffered severe burns and nerve damage (with on-going pain and disability) from being scalded in a tub as a toddler. These are daily reminders for him. It was only after his mother died that he could achieve any sense of peace and safety (not an option for most). In his case, we took the approach of differentiating how his abusers considered him (contaminated) vs. how we did (a kind, caring person we all really like).

      I also wonder how this would differ when the abuse is familial vs. non-familial? You could easily stray down the problematic path of the survivor sharing DNA with their abuser, which the ‘cell renewal’ imagery might accidentally reinforce.

      • Maeve Grogan, Artist Bend,Oregon says:

        Hi Anne,

        Something that was helpful for me in healing was said by Jack Kornfield in a NICABM seminar on mindfulness a while back (I think 2013)… that the practice of forgiveness is not just a nice thing to do for the other person (the wounder), but benefits greatly the person forgiving (the wounded). As difficult as it is to forgive, especially if there is ongoing assault, the practice can create more space for internal freedom. This does not mean stay in an abusive situation and ignore reality, rather move more into a bigger picture through this practice. In my personal experience, I found experimenting with mindfulness and compassion for the wounder as well as myself, opened the story out, and the repeated assaults became less personally felt, and more telling about the other person’s pain and anguish, as they stayed in a damaging pattern that I was consciously seeking freedom from. The bigger picture, that we all share in this life, is that at times, this is a world of wounds and wounding. This understanding can help release some of the toxic shame around the secret, private damage, that feels so isolating to a person. Mr. Kornfield stresses that this practice is not to be forced, rather to only go as far into the process as feels safe and tolerable. If this sounds like a possible fit, maybe Ruth can provide a link for you to the old webinar. I also think that understanding the biology of fight flight freeze faint and fright helps the person connect with their body, and in that, gain a felt sense of how their reactions and aversions are biological responses, not unique to them alone, and that there are caring people developing exercises that will help them notice their arousal, find some space around it, and find a return to center. :-) Maeve

        • Herbert, Psychiatrist and Psychotherapist, Winterthur, Switzerland says:

          Thank you for your post.

    • Laura J. Nigro, M.S. • SciEnspire.com • Durham, NC says:

      I have a similar puzzle: How to help survivors with any problematic scars, blemishes or even tattoos embrace this full cell replacement story? Not that such marks are necessarily associated with their past trauma (though they certainly can be, esp. for military service personnel). Just that some victims construe the natural persistence of visible scars and tattoos as proof that some “human stains” are permanent.

  21. Iiris Bjornberg, Life Coach, Helsinki, Finland says:

    Thank you Ruth, once again, for excellent information! – Which is a reminder. I remember when the study was published, I think that you commented on it back then already. It’s a powerful way to ‘prove’ the brain that the feeling of contamination and shame is an illusion. When the brain ‘gets’ it, there’s a new thought of the whole thing which can change the body’s response. I’ve seen it work, literally – the clients’ posture changes, they stand straight!

  22. Jean says:

    Sounds useful and interesting. Are these journals available electronically?
    Have a nice day.

    • Nancy, NICABM Staff says:

      Hi Jean,

      You can find the abstract of the study in Volume 82, number 4 of the Journal of Psychotherapy and Psychosomatics here: https://www.karger.com/Journal/Home/223864. The full version of the study is available for purchase and download.

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