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Key points
- Someone can help themselves get unstuck and tell their therapist important or even "shameful" information.
- Shame—and overlearning how to stay silent—can prevent clients from discussing key issues.
- Between-session mindfulness and behavioral exercises can be helpful as well.
A lovely person I once knew had been seeing a therapist for over three years, but she never told him that she was using cocaine. I urged her to bring it up in a session. She consistently refused. After a while, we lost touch, but I heard from a friend that she had been hospitalized for depression after a suicide attempt. I was very saddened to learn that news, and I wondered what would have happened had she told her therapist.
Why do so many people not tell therapists something important? Why do they, session after session, not mention that they were abused by a family member, raped, are using cocaine, addicted to porn, binging on some form of media, etc.?
Don’t think about it... let alone talk about it.
Some people don’t even let themselves think about what happened, let alone consider telling their therapist. Just thinking about it brings up waves of discomfort and shame. A recent paper published by researchers at Yale University and the Icahn School of Medicine at Mount Sinai in New York (Perl et al., 2023) suggests that traumatic memories are processed in a here-and-now part of the brain as if they are happening at this very moment. No wonder people avoid thinking about what happened!
On the other hand, some people have intrusive thoughts. They would love it if thoughts about what happened would disappear, but even then, they may not tell their therapist.
Don’t say that!
I like to think that there is a committee upstairs. That is, there are lots of neural networks, and some of your “committee members” (neural networks) don’t get it right. You will not die of shame if you open your mouth. But various “committee members” may be telling you, “Don’t say that!”
Why is it so difficult?
Maybe you kept yourself safe for years by keeping your mouth shut.
If you practiced keeping silent for years, why would you expect it to be easy to finally open your mouth and talk? It won’t be. It will make you uncomfortable, perhaps very uncomfortable.
Your brain wants to keep you safe. Fortunately, some aspect of you—A “higher self?” Your “ego?” Your “wise mind?” Your “essential self?” I don’t know what you might like to call it—wants to do more with your life than simply be safe. That self would like to talk about this never-to-be-talked-about issue.
Maybe your therapist will “leak.”
Perhaps you intuit that your therapist may “leak.” Especially if you have been betrayed in the past, you may not trust that the information won't somehow get out.
Have you given your therapist permission to talk to someone else—your psychiatrist? Another therapist? Someone in your family? If so, you may need to rescind it. Your subconscious does not trust that your therapist won’t say something to that person, and that person may say something to someone else, and... This may not make sense to you, but a lot of what we think and feel and may even do doesn’t necessarily “make sense.”
Toxic shame
Many years ago, John Bradshaw popularized the concept of “toxic shame.” Toxic shame is about your entirety. It is accompanied by thoughts that you are a total screw-up beneath contempt. You should go hide in a closet or in your bed.
People never do anything useful or helpful when they are full of shame. They also often avoid feeling shame at all costs, keeping any thoughts at bay that their committee might toss up by overdrinking, smoking weed, overworking, etc.
Shaming and blaming
I joke that if shaming and blaming helped, I would coach clients on how to do it better. But it does not work. Many of us had parents who only wanted the best for us, but they deeply believed that shaming and blaming helped change people’s behavior. No doubt, you did change many behaviors as you grew up; however, in many cases, but not all, not because of being shamed or blamed.
Can your therapist deal with it?
If there is something that you are not telling your therapist, is that partly because you’re not sure that your therapist can handle it? Research by Dr. David Kraus, President and Founder of Behavioral Health Laboratories in Massachusetts, and his associates clearly indicates that no therapist is good at treating everything. Their research suggests that most therapists and counselors are good in five or six areas. None was found to be good in all 12 areas included in the study.
You don’t have to stop seeing the therapist you are currently working with, who may be very good at dealing with depression or panic attacks or relationship issues. You can very effectively work with two therapists at once, despite what some therapists may say, just like you can work with an internist and a cardiologist at the same time.
Last-minute therapy
For years, therapists have noticed that clients sometimes bring up something very important at the end of a session. It is as if they want us to know about an issue, but they don’t want to have to deal with it—talk about it, process it—at that moment. It is an effective strategy. It gets the issue out in the open, and then you can discuss it in the next session if you want to.
Specifically, tell your therapist that there is something that you would like to work on, but you’re too uncomfortable to talk about it. You may want to add that you have a hard time trusting anyone enough, even your therapist. Hopefully, your therapist will tell you that you can talk about it when and if you want to and at your own pace.
Hopefully, they won’t push you. It will come out because, ultimately, you want it to come out. But it may take time.
Between-session therapy: A mindfulness approach
If you observe that shame is a major problem for you, besides telling your therapist and working on it in session, you may also want to work on it between sessions. R.A.I.N., a mindfulness approach developed by mindfulness teacher Michele McDonald, suggests that you can help yourself by learning and practicing four steps: Recognize what you are thinking and feeling; accept it without immediately trying to get rid of it or change it; investigate... that is, dig a little deeper, spending some time reflecting or meditating on where the feelings and thoughts may come from and whether or not they have any merit or are helping you; and non-identification, that is, don’t identify with all of your thoughts and feelings.
Psychologist Tara Brach has changed the "N" to nurture, and I would add, be kind to yourself. You did not ask for what you are grappling with.
Between-session therapy: “Shame attacks,” a behavioral approach
Some readers may find that a more behavioral-based approach will help. Dr. Albert Ellis, the founder of rational emotive behavior therapy (REBT), thought that shame was such a strong emotion that when it wells up, people don’t know how to cope with it. Consequently, they may avoid anything that might trigger shame and do things like numb themselves to prevent themselves from feeling it.
To help, you can trigger shame at your own choosing by doing “shame attacks” and thereby learn how to manage and respond differently to shame. One person I know went to a meeting without makeup. Another went to work at his bank purposefully wearing mismatched socks, one dark blue and the other black. Gradually, they “re-wired” their brain and learned never to feel shame. They might feel annoyed or embarrassed but not ashamed. It may sound silly. But doing a shame attack may help you gain considerable insight into what is holding you back.
To find a therapist near you, consult the Psychology Today Directory
References
Bradshaw, J. (2005). Healing the shame that binds you. Recovery classics edition, Health Communications, Inc.
Collard, J., & Clarke, M. (2020). Experiential learning for trainee therapists through a shame attack exercise. the Cognitive Behaviour Therapist, 13, e53.
Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart.
Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S. S., & Hayes, J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapy Research, 21(3), 267-276.
Perl, O., Duek, O., Kulkarni, K. R., Gordon, C., Krystal, J. H., Levy, I., ... & Schiller, D. (2023). Neural patterns differentiate traumatic from sad autobiographical memories in PTSD. Nature Neuroscience, 26(12), 2226-2236.
