Trauma can leave a patient with a deep sense of unworthiness. On top of that, your client might even blame themselves for feeling this way.
But as we know, there’s always a purpose behind a patient’s response to trauma. And sometimes, the challenge is getting your patient to see the wisdom behind their response – especially when that response is fueling shame and self-blame.
In the video below, Janina Fisher, PhD shares a trauma-informed way of framing a patient’s sense of unworthiness.
She’ll also walk you through specific language you can use with clients who insist on their unworthiness after trauma.
Take a look.
I should say sometimes, clients will say, “You think this is surviving? I got to live so I could be tortured by shame for the rest of my life?” And I say, “Well, that’s why we’re here – so that you can say, ‘I’ve survived and I’m not tortured by shame.’”
For a more in-depth look at how to work with the collapse/submit response, check out the Advanced Master Program on the Treatment of Trauma.
In this 5-part program the experts go beyond the fight-flight-freeze model and look at several emerging defense responses to trauma – including please & appease (also known as fawn), attach/cry-for-help, and collapse/submit.
Now we’d like to hear from you. How do you work with patients who are stuck in the collapse/submit response? Please let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
Helping Clients Talk About Shame
How Feeling “Never Good Enough” Can Get Passed Down Through Generations
[Infographic] – Four Key Ways Collapse/Submit Can Present in a Client
This was a great approach to someone feeling they are unworthy….I like how you showed the client That her or his ability to respond with survival makes them worthy!
Great stuff!
I literally just helped my 90 yr old great auntie (a retired RN & MSW) heal her past story of unworthiness!! Just in time for her 90th birthday.
It is literally never too late to be set free or to set someone free!! She’s loving her new life of love & worthiness! And it’s only been about 5 weeks!
It would differ with each client of course, depending on the level of rapport and trust between us, their history, vulnerability, safety & openness.
I would probably initially comment on what I had noticed; that it appears in response to (whatever the traumatic event was) that you have collapsed and submitted.
I would initially ask what purpose they think that response may have served – at the time.
I would invite them to consider what other options were available to them – at that time – and what the possible consequences/outcomes of those options may have been.
I would then ask if they thought differently about their collapse/submit response now, after consideration.
Depending on their engagement I may now invite them to consider what the possible consequences may be of remaining in that mode of collapse and submit now. I may then ask if they may be curious about considering the consequences of exploring alternative responses if and when they felt safe to do so and how I may support them to do that.
Wow, what is so layered and steeped in family developmental stages summed up beautifully . ….this gives the individual a great deal to think about and resonates to me as a story as old as time. This is a remarkable tool ( your series) …grateful ❤️
Confronting a belief that rules the person’s life requires great skill and patience from the therapist part.
Thank you!
This video is awesome! I love the way Janina Fisher has elaborated on unworthiness and how to tackle it with ease. To top it even there is a script of the video.
Thank you very much for these wonderful videos and infographics. They help me lot in my practice. Love you all.
Lot of gratitude to NICABM and all the experienced practitioners who give away fantastic content for free for us private practitioners.
Deeply insightful, brilliant in fact. This interview with Dr Janina Fisher explains very clearly where the core sense of unworthiness comes from. It makes total sense. Thank you.
From a psychodynamic/psychoanalytic perspective, would Fisher’s description of trauma and unworthiness reflect splitting of self/other and the client being bad or contaminated with badness?
A great question. Would definitely want to explore this. Seeing it from Internal Family Systems lens may help.
SO powerful, thank you. Why is it not obvious that there’s more than one story?
Good to get a reminder.
I need the practical training and practical internship and the latest training trends .I have completed the Master’s degree certificate from Tamilmadu Open University Saidapet Chennai India during July 29th 2021 with I subclass distinction. I am awaiting for the convocation letter from Tamilnadu Open University Chennai India. Awaiting the reply at the earliest. Thanking you :Yours faithfully : (Sudarshan Shrikanth.)
Feeling of unworthiness is a deeply rooted sensation in my body. When I look inside for an image of it, I see it smeared on the walls of the crack in my body along the heart. The crack is an internalized parental divorce at the age of 4. Unworthiness is my nervous system response to the shock of their split. Split that sent me into submit and shame response. Four decades later I started a healing process using many different modalities. Different energies coming up from the bottom of the crack up my body and I have been slowly healing an old wound and many that piled up on top. I am curios how does unworthiness feels and looks in other trauma survivors’ bodies.
Thank you NICABM for great programs, infographics, resources, and all you do to help trauma survivors to heal.
Thank you for sharing. I liked how you articulated the trauma as a crack in your body along the heart. To me it makes me want to withdraw, I feel unworthy to be a part of things or less than others. I pull myself out of that and remind myself that I too deserve healing, respect and to feel good in life despite past experiences
This came right in time, since I have 2 clients that fit the description. I may send them the transcript, since they both talk about being worthless. And I do say “not in my way of looking at you. For me you ate a worthy person, that is why I stick with you” but explaining it is a thought rather than feeling, and it was a good survival mechanism is briliant.
A ,Novel idea that “IT” the ‘feeling of unworthiness’ is not a feeling really bet it is a Belief! wow and then one is offered another point of view, so there is a choice now ,to agree or not to agree.Trauma takes the choice away though.It is brilliant the way dr janina Fisher introduces this process to the mind of the patient and then the possibility of Empowerment and transformation. phenomenal.
Thank you.for showing us how Our minds r very clever in how we trick ourselves when we r abused by our caregivers and how these abusive caregivers help make us submissive to their mental illness , until those like u appear to educate and care the victims back to wellness and wholeness. Our society is to often too busy and undereducated to understand what these victims go thru and how they survive in society with others who may also prey upon their vulnerabilities , conditioned values and beliefs that r distorted by abuse Sharing this info helps us be more compassionate re their pain and journey to heal . And how we can be more tolerate of othrs .
My clt. has the Freeze with non decision active response. She is an 14 y.o adolescent. We are working with her self esteem confidence & to feel safe with her various environs, grandmom.s care & adoption over the last 2 yrs & transition into 9 th high school, from a special education school in her elementary school years.
Thank you for this insightful snippet from Dr. Fisher. I consider it progress when a client finally acknowledges that their mind-heart-body did not betray them in the midst of trauma but instead protected them with unique survival strategies. After they accept this reality then we can begin to explore the deeper dynamics of shame, unworthiness and protective layers of denial. I also ‘go to their body’ by establishing first bodily awareness then nervous system regulation-so many people are quite disconnected from their integrated self. I also develop shared understandings of feelings, thinking, emotions, soul and heart. Then we share and communicate in common language about their difficulties so that meanings are resonant and so that new neural pathways are practiced in session and reinforced over and over again. Beautiful offerings NICBAM, much gratitude.
like your style 🙂
I’ve been trying a similar thing with one particular client, as I realized that these are all beliefs and she’s dissociated from her feelings. We’ve been doing a bit of mindfulness and trauma-informed yoga.
I wonder how helpful Janina Fisher’s question would be for this client. It’s possible that if she had stood up to the bullies, that they would have backed off. Maybe the question for clients like this is more, “what did you fear would happen if you looked at him like he was a bad man”? I’m just brainstorming here…
Half a century ago my degree studies were simply described as “Child Study.” As a student at a Massachusetts womens’ college the course focused on the works of Piaget, Brunner, Hebb, Skinner, on educational processes both current and historical:early child development as it regards physiological psychology. In the work world university degrees as a measure of personal ability did not ,in my case, translate across all the boards of family backgrounds, experiences,cultural divergencies, I often found that specific informational studies , especially as a young woman, were often counter productive. I felt my studies represented only one small piece of the human behavioural puzzle. Fifty years later, many more years of continuing study and work has reduced my original divisionary approach between therapist/teacher or patient/client. My mentor of over 35 years once said that the most important thing to remember was that anyone who crossed the threshold of my practie came to heal me. So framing a client in accordance to any label, reduces my ability to aid the client’s own ability to embrace real personal change for themselves. REAL change not just the appearance of change. This means opening my horizon beyond formulised boundries,beyond dualistic therapist/client boundries.Without my own daily practices, be they medative,or somatic breaching this duality means a type of co-regulation with my clients which indeed releases both of us from being “stuck” in a response that is neither forced nor synthetic. Thank you for your posted share.
Beautifully said. I will also take your mentor’s words as my own. Thank you.
I disagree. and I live what you talk about and am pulling myself out by myself. I believe I felt worthy enough to stay alive so therefore went into freeze. And it was the secondary layers of living in a freeze state much of my life without realizing it and all the judgments and ridicule that comes with that that caused unworthiness. And I will even take it further, self-destruction for me was about reclaiming my power. I will harm myself before you can kind of thing. you have to live this to understand it.
I find that through your creative ,brilliant and little warrior brain/mind, you disarmed and defeated these cruel bigger bodies and brains ; thus survived . However now you are not the same ie.an adult now so they also do not have the same power over you. You can switch over to ‘Thrive state’ from survival state and with appropriate therapy could perhaps allow to self soothe, regenerate and self nurture and eventually grieve you losses from childhood.
just a suggestion.
This is resonant with me as I experience nerve pain in response to fear and other unknown unconscious things but always sensed it was some form of self regulation like cutting.. so your response post here is giving me an insight about it… beyond just thinking I’m a masochist… thanks.. yes only those who experience and live it can understand.. for the others it’s just theory
Fisher’s astute articulations are rich with kindness. Beautiful. I agree that collapse is a brilliant survival strategy and when a patient admires their own collapsing as such we can begin the journey to develop new ways to replace the old ways in every way! Once we pay respect to the old ways they can yield and allow new strategies to emerge, i.e. numbing for expression.
I’m reminded of something Rollo May? called pseudo-innocence.Thank you and all your colleagues for this and all share. I’m a mediator and spiritual guide and remain grateful for all you all bring to the circle.
When my father left I was three years old. Suddenly my world changed. I had no choice but to retreat behind a mask of indifference which solidified my shame. I was three. My survival depended on my mother who suffered her own shame. I have spent most of my adulthood, fifty years, searching for someone to see me behind my wall. At the bottom of it all is fear and shame. Years of therapy, joining different self help groups etc. . Not until now have I heard words that break through, that make sense. Now I need to find a counselor to help me, to work with me to break down the wall inside. Please take this work seriously. The world needs it.
Amen, sister. Thank you.
Good morning, Dr. Fisher!
Your quick lesson above gave me a grin and a bit of joy. “Shame” was an issue which I have addressed with only one of the people whom I have served as a spiritual guide in the past few years. Her age (mid-nineties) and COVID left us no opportunity to pursue it.
I don’t know that I would have done well with her had we spent more time together, for “feelings of unworthiness” have been an unresolved struggle for me personally through the years. How then could I grin with joy this morning, you may ask.
Well … as you introduced the topic with the consideration that there might be wisdom behind the response, behold an epiphany. My immediate response was, “Wow! Feeling unworthy kept me from fighting when I was too weak to overcome the situation!” I am certain my elderly friend could have benefitted from such knowledge, but know she is now in a place where she will never again feel unworthy. I thank you that I will have this wisdom to share with others, as needed.
I keep signing up for these free lectures, etc. even though (at 79) my own doctoral pursuits rarely allow me the time to catch any of the full lectures, but little snippets such as this morning’s, are very helpful. I am grateful to NICABM and all of the participating professionals.
Blessings on your work,
Carol
Thank you, Carol. I, too, am a snippet student, grateful, and still eager to learn, share, and practice.
When working with a survival adaptive belief, I will usually go to the body to explore where the felt sense of this belief is and more importantly what this part offers the client in terms of managing the trauma at the time but also managing the impact of the trauma right now. Ie what’s ‘good’ about this belief..acknowledgement and inclusion of this adaptive mechanism can usually over time allow space for recognising other parts tgat may have another point of view and may offer a different energy..the main belief can start to be less coupled with the trauma event and over time more and more choice for response can come online.
Body wisdom, absolutely. And then the words…the power is also in the naming. Thank you for your comment Dierdre.