Helping Clients Talk About Shame - Ruth Lanius

When Clients are Reluctant to Talk About Shame

Working with clients who suffer from deep feelings of shame can be a delicate and nuanced process – for a few reasons . . .

To start, shame can disguise itself in a number of ways. It can hide beneath anger, outrage, self-sabotage, or abusive relationships.

What’s more, clients often develop a set of defenses that can make it difficult for them to talk about, or even admit to, feelings of shame.

When that’s the case, here are two things that might help. First, we need to be on the lookout for signs that can clue us in to the presence of shame – even when it’s subtle. And second, we need strategies that can help clients feel comfortable talking about it.

So in the video below, Ruth Lanius, MD, PhD, provides three cues that can help therapists detect shame’s presence. Then, she shares a simple question that can help clients begin to open up about feelings of shame.

Have a look.

Click here for full transcript

“Dr. Lanius: There are a number of cues I always look out for when I see somebody who I suspect has shame. And one of course is this downward gaze. So when individuals have significant shame, they often have difficulty looking me in the eye. So you see this downward gaze. You also see this slumped posture. And that’s often a very big cue for somebody experiencing shame. So slumped posture, downward gaze, and lack of eye contact.And what I’ve learned from my patients is asking about eye contact is also a very good way of getting at shame. And for example, when I see my veterans or first responders, I usually use this scenario and I say to them, “One of the veterans once told me, ‘When I look anyone in the eye, I fear that they will see the stain on my soul.'” And I say to them, “Does that ever happen to you?” And very often there’s a pause. And then they tell me about the experiences they feel very ashamed about.When I see civilian clients with a lot of history of childhood trauma and where I suspect there are feelings of shame, I often ask, “What’s it like for you to look someone in the eye?” And they often say to me, after a pause, “I’m afraid that people will see how bad I am.” And I think that’s really the essence of shame, right? It is I am bad. That feeling I am bad. Whereas guilt is I’ve done something bad, shame is about feeling “I am bad.” So really asking individuals about what it’s like to make eye contact, I think really opens the door about getting at shame. I find asking about guilt and shame directly, just asking, “Do you feel guilt and shame often?” You get something, but I find that you get a lot more information when you ask about what’s it like to make eye contact.”

If you found this video helpful, you can hear more about how to help clients break free of a powerful cycle of shame from some of the top experts in the field, like Bessel van der Kolk, MD; Marsha Linehan, PhD; Peter Levine, PhD; Richard Schwartz, PhD; Pat Ogden, PhD; Stephen Porges, PhD; Shelly Harrell, PhD; and more.

Now we’d like to hear from you. What are some other ways that you recognize or work with shame? Please let us know in the comments below.

If you found this helpful, here are a few more resources you might be interested in:

[Infographic] Shame vs. Guilt – A Client Handout

A Simple Metaphor to De-Shame a Client’s Trauma Response, with Ron Siegel, PsyD

Treating Trauma: How to Work with the Shame of Moral Injury

10 Comments

Sue Richardson, Psychotherapy, GB says

Lack of eye contact is also characteristic of avoidant attachment. Another factor to bear in mind that some types of organised abuse forbid eye contact in the pursuit of dominance or to prevent victims identifying their abusers.

Kim says

Hm, not my experience. Some people, like me, can be shy and there’s nothing more to it. Also, many cultures view eye contact as rude or confrontational.

Monica Nowakowski, Social Work, Berkeley, CA, USA says

Thank you for this video. I will definitely use this in my practice.

Elizabeth Neervoort, AU says

Shame requires a voice so that the individual doesn’t slip through a crack in the floor. We have a right to speak up and ask for our needs to be met. In this way the individual is challenging their skewed beliefs around their perception of themselves.

Marcy Harms, USA says

This is so true of military and those who are in treatment as I have experienced this lack of eye contact. Posture has not been an issue and I think it has to do with military stances demanded but they are great when you see them relax as a great cue to forward movement. Thanks for the reminder as I need this a lot lately. Love to hear your soothing voice and bet the clients appreciate you calm presentation.

Marcia Harms, Marriage/Family Therapy, WA, USA says

This is so true of military and those who are in treatment as I have experienced this lack of eye contact. Posture has not been an issue and I think it has to do with military stances demanded but they are great when you see them relax as a great cue to forward movement. Thanks for the reminder as I need this a lot lately. Love to hear your soothing voice and bet the clients appreciate you calm presentation.

Linda C, Teacher, CA says

Very insightful advice. I’m not a counsellor but I benefit from reading your messages.

Carmen Diaz, Psychotherapy, Pequannock , NJ, USA says

Had noted one of the foundation of shame is Guilt! “I did something so shameful and I am guilty” Once my clients start acknowledging the guilt feelings we could start working on the shameful aspects of theirs actions.

Ann Palmer, Coach, GB says

This is a wonderfully illuminating and simple wee video that is deeply empowering. I am not a therapist but work in the field of eco-therapy so there are strong links for me with the whole field of healing.

Thank you so much for this! 3 minutes of great advice in an otherwise frustrating morning on the internet!

Gretchen Kennedy, Clergy, Wilmington, DE, USA says

I like the question, “Can we rephrase that to bring it to a 50/50 balance point?” In other words, a shameful statement like “I don’t know how to love, I always block love,” can be balanced (and will align them with every human) with “I am loving, and sometimes I don’t know how to love or find my heart.”

When Clients are Reluctant to Talk About Shame

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