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A Master of Counselling dissertation on the relationship between shame and the presenting issues of those seeking therapy.
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University of Notre Dame Australia
School of Arts and Sciences
Counselling
SHAME: THE INGENIOUS QUILT
A study of the relationship between shame and the
presenting issues of those seeking therapy
Alistair P D Bain
B.D. (Hons), Grad. Dip. Inf. & Lib. Studs., B.A. (Hons)
October 2011
CN606
Dissertation
In partial fulfilment of the requirements for the award of
Master of Counselling
University of Notre Dame Australia
Fremantle campus
Shame: the ingenious quilt
i
Statement of Original Authorship
I declare that this is my own work and that to the best of my knowledge and belief it contains
no material previously published or written by another person except where acknowledged
and cited.
Signed …………………………………………..
Alistair P D Bain
Date ………………………………
Shame: the ingenious quilt
ii
Acknowledgements
jIdw;n de; tou;" o[clou" ejsplagcnivsqh peri; aujtw'n o{ti h\san ejskulmevnoi kai; ejrrimmevnoi wJsei;
provbata mh; e[conta poimevna.
TO the many who have been my shepherds, thank you:
The Rev’d Judith Peterkin, whose insights during the summer quarter of
Clinical Pastoral Education at Royal Perth Hospital (1991-1992) first raised
my interest in this fascinating topic.
The four therapists whose willingness to participate in this study provided
not only the core data, but also an education in itself.
Dr Erica Usher, my Clinical Psychologist, whose own insights and
therapeutic care during “the therapy hour” have been unquestionably
beneficial, and a powerful example of “being held in the mind of an other”.
And finally, but no less significantly, thank you to the Counselling course staff of the
University of Notre Dame, Australia, Fremantle campus, family members, and friends – the
indispensible, and the sine qua non!
Shame: the ingenious quilt
iii
A B S T R A C T
Shame is commonly described in the literature as “painful”, which may account for the
relative poverty of research into this affect, compared, for example, with anger or abuse. Part
of the problem is that the terminology for the affect, shame, has yet to be conclusively settled,
and debate continues as to whether shame is a distinct affect, or the extreme emotion in a
continuum that might include embarrassment, shyness, and humiliation. In addition, a long-
standing confusion between and conflation of shame and guilt exists. The research leans
heavily towards a phenomenological, psychic and physiological distinction that empirical
studies – both quantitative and qualitative – repeatedly confirm. Equally significant is the
likely, almost inevitable, question of “disguise”. Shame notoriously lies, not merely dormant,
but deliberately hidden. Exposure of perceived flaws is the greatest terror for the shame-
based person. Nevertheless, shame may well be the underlying pathology in a range of
presenting issues, especially abuse. This study seeks to examine some of those issues and to
determine whether clinicians recognise or deem it appropriate to tackle shame itself, or
alongside the presenting issues clients bring into therapy. Using the qualitative approach of
interpretative phenomenological analysis (IPA), the research examines responses from four
psychotherapists, all of whom recognise the presence of shame in their clients’ presentations.
Although the therapists’ backgrounds and theoretical perspectives vary, the majority
effectively use non-judgemental, non-shaming approaches with their clients, in other words, a
person-centred approach that seeks to form a therapeutic relationship of trust and validation
of emotion and experience. The significance of shame for further research, possible inclusion
in coursework, and for clinicians lies in the under-researched nature of shame, its prevalence
in all cultures and communities, and in the breadth and diversity of shame’s presentation in
the therapeutic landscape.
Shame: the ingenious quilt
iv
TABLE OF CONTENTS
Statement of Original Authorship i
Acknowledgements ii
Abstract iii
PART 1: INTRODUCTION
1.1 Overview of topic 1
1.2 Context of topic 2
1.3 Emergence and importance of topic 2
1.4 Research questions 3
1.5 Terminology 4
1.5.1 Shame and guilt 5
1.5.2 Healthy shame? 6
PART 2: LITERATURE REVIEW
2.1 Introduction 9
2.2 The literature in detail 10
2.2.1 Shame in overview 10
2.2.2 Shame and guilt 13
2.2.3 Shame, attachment and developmental theory 17
2.2.4 Shame and abuse 25
Shame: the ingenious quilt
v
2.3 Towards a summary and conclusion 30
2.3.1 Treatment and healing of shame 30
2.3.2 Concluding overview 32
PART 3: METHODOLOGY
3.1 Introduction 33
3.2 Interpretive phenomenological analysis: theoretical underpinnings 34
3.2.1 Phenomenology 34
3.2.2 Hermeneutics 38
3.2.3 Idiography 40
3.3 Method 41
3.3.1 The sample 41
3.3.2 The participants 42
3.3.3 The data collection instrument – interview schedule 44
3.3.4 Interview particulars 45
3.3.5 Sequence of analysis 47
PART 4: FINDINGS
4.1 Introduction 49
4.2 Thematic narrative 49
4.2.1 Foundational issues 49
4.2.2 Shame theory 54
4.2.3 Presenting issues 70
4.2.4 Therapy 77
4.3 Conclusion 86
Shame: the ingenious quilt
vi
PART 5: DISCUSSION
87
PART 6: CONCLUSION
90
REFERENCES
91
APPENDICES
Appendix A Information Sheet 102
Appendix B Consent Form 103
Appendix C Data collection instrument – interview schedule 104
LIST OF TABLES
Table 1: Participants 105
Table 2: Themes and sub-themes 105
Shame: the ingenious quilt
1
PART 1: INTRODUCTION
1.1 Overview of topic
Those who write about shame commonly describe it as one of the most painful of
human experiences (B. Brown, 2008; Kaufman, 1991; Middleton-Moz, 1990;
Nathanson, 1987; Nathanson, 1992; Tangney & Deering, 2004; Tomkins, 1963). B.
Brown (2008) further asserts that ―shame is universal – no one is exempt‖ (p. 3). In
that context she suggests that even for mental health professionals the act itself of
discussing shame with patients will invoke shame issues for those professionals (B.
Brown, 2008).
The deliberately-ironic subtitle of the research project seeks to encapsulate,
metaphorically, the complexity of this ―universal‖ (B. Brown, 2008, p. 3; Heller,
2003, p. 1018) affect whose manifestations are multi-faceted and sometimes
contradictory or paradoxical (Nathanson, 1987; Middleton-Moz, 1990). Nathanson
(1987) offered the academic community shame‘s ―many faces‖ and Middleton-Moz
(1990) spoke of shame (and guilt) as ―the masters of disguise‖. It is shame‘s ability to
manifest itself in numerous disguises, with many faces, that makes it ―ingenious‖. It
resembles the quilt for similar reasons: a quilt is an amalgam of many elements of
fabric, three layers deep. It is also a covering, just as shame seeks the covering of its
multifarious disguises. The central irony is that unlike the usual connotation of
ingenuity, shame‘s ingenious nature not only causes intense pain to the person bound
within its fierce perimeter, but its quilt-like covering is deceptive and lacking
authenticity: the shame-quilt appears to offer a person protection, but the costs are
exorbitant and the quilt itself is extremely fragile rather than truly protective.
Shame: the ingenious quilt
2
1.2 Context of topic
B. Brown‘s (2008) observation concerning the purported universality of shame
notwithstanding, the specific context of this research project is the actual therapeutic
environment. The underpinning assumption is that shame is pervasive and therefore
likely to manifest itself in one or more guises when a person seeks therapy.
Within that context, the researcher wanted to test a second assumption: that therapists
might not recognise shame as a critical issue for clients, focussing instead on arguably
more obvious pathologies. As the findings suggest, this proved not to be the case,
with all interview participants being able to recognise and articulate shame as a
significant issue. The psychotherapists interviewed were also able to shift their focus
in response to obvious shame manifestations.
1.3 Emergence and importance of topic
The researcher first became interested in shame during a ten-week course of Clinical
Pastoral Education (CPE) at Royal Perth Hospital, Western Australia, undertaken as a
partial requirement for ordination as a priest in the Anglican Church. The clinical
supervisor of the course observed underlying shame issues in many of the researcher‘s
behaviours and reactions. The researcher‘s subsequent reading on the topic produced
a prize-winning essay1, but more significantly explained much that had previously
mystified and disturbed him.
1 The Sambell Prize (Australian Health and Welfare Chaplains’ Association).
Shame: the ingenious quilt
3
The CPE course thus sensitised the researcher to instances and manifestations of
shame during the course of his pastoral work within the Church, and in the wider
community.
Within the academic sphere, the researcher notes that shame has received less
attention than other affects, for example, anger, and is rarely the subject of dedicated,
specific research. One of the pertinent issues is that it has proven difficult to create
and undertake empirical research on shame. Nevertheless, some of the literature (see
below) suggests that researchers are beginning to make attempts to study shame in a
more systematic, evidence-seeking manner.
The relative poverty of research and the pervasive (arguably universal) nature of
shame (Lewis, 1995; B. Brown, 2004) make this affect particularly significant for
further study and research.
1.4 Research questions
The research question that informs this project is
What is the relationship between shame and the presenting issues of those
seeking therapy?
The researcher was interested in discovering some related, underlying issues:
To what extent did psychotherapists recognise shame or shame-based
behaviours in their clients?
How did psychotherapists distinguish between shame and guilt?
Shame: the ingenious quilt
4
What methods did psychotherapists use in navigating the likely-to-be-fraught
passages of shame?
To this end, the following questions served as the guiding basis for the semi-
structured interviews that ensued:
What do you understand by ―shame‖? How common is it for clients to present
with shame?
In your view, what is the difference between healthy shame and toxic shame?
To what extent do your clients recognise shame as a therapeutic issue for
them? How is shame manifested by clients?
If you are treating a client‘s shame as a significant therapeutic issue, what
strategies or therapies do you use?
How would your therapy approach differ if shame is a peripheral issue for
clients? How would your approach differ from working with clients who are
not shame-based?
In your experience, what are some of the ways clients try to mask or hide their
shame?
What is it, in your view, that helps resolve issues of shame?
The questions themselves provided a skeleton that the researcher believed offered
sufficient material for the psychotherapists interviewed to flesh out. This proved to be
a justified belief. The therapists whom the researcher interviewed provided rich,
example- and anecdote-laden responses that gave answers to these questions without
them (necessarily) having to be asked specifically.
1.5 Terminology
It is necessary to be clear about the use of the word shame because confusion exists
both in the literature and in common use about what constitutes the affect, shame, to
the extent that the word itself is used to describe what is more accurately referred to as
Shame: the ingenious quilt
5
guilt (Middleton-Moz, 1990; Tangney & Dearing, 2004). As Tangney, Mashek, and
Stuewig (2005, p. 44) observe: ―Much emotion research, especially research on the
self-conscious emotions, hinges on self-report. Yet, in the domain of emotion, we can
be easily misled by words.‖
1.5.1 Shame and guilt
It is possible to make a rough distinction between shame and guilt. Following
Nicolosi (2009) the broad difference is that shame says, ―You are bad,‖ while guilt
manifests as, ―You did something bad,‖ (p. 267). In other words, shame invades and
inhabits a person‘s sense of being, while guilt associates itself with what a person has
done.
Tangney and Dearing (2004, pp. 78-89) speak in terms of a person‘s capacity for
empathy and ―other-orientation‖, suggesting that while any given guilt episode may
enhance empathy and ―other-orientation‖, a shaming event will interfere with, reduce
or negate empathic feelings. This is because the person who does something (that is)
wrong is able to retain an understanding of how their actions affect an other. The
person who feels shame, however, is self-absorbed, living with a quiet but terrifying
desperation to remain hidden, and the terror of being uncovered, discovered to be a
flawed and unworthy being: such a person is unable to understand their behaviour
with reference to the other (Gilbert, 2003; Kurtz, 2007; Tangney & Dearing, 2004;
Wright, Gudjonsson, & Young, 2008).
Shame: the ingenious quilt
6
1.5.2 Healthy shame?
Some shame theorists and thinkers have suggested that a difference exists between
healthy and toxic shame, arguing that healthy shame not only exists, but is a
legitimate organising principle in society, as well as a moral guidepost (Bradshaw,
1987; de Hooge, Zeelenberg, & Breugelmans, 2010; Fossum & Mason, 1986; Stiles,
2008; Ryan, 2008).
Stiles (2008), for instance, argues that shame can act as motivational force and ―help
social cohesion‖ (p. 1). In a similar vein, de Hooge, Zeelenberg, and Breugelmans
(2010) argue that shame can motivate what they call ―approach tendencies‖ (p. 111).
By this, they mean ―approach‖ with a view to making amends for wrong-doing (ibid.).
Ryan (2008), under the heading ―Shame is integral to healthy human functioning both
personal and social‖, compares shame with anger and fear, suggesting that ―there are
some things we should be ashamed of‖ (pp. 9-10). Such a proposition would certainly
resonate with proponents of ―naming and shaming‖.
The researcher was initially of the opinion that toxic shame certainly occurred as a
pathological condition requiring healing, and in principle accepted that therefore the
obverse (healthy shame) theoretically had to be considered alongside its notional
affect-sibling.
However, he is now persuaded that any notion of shame being ―healthy‖ is mistaken,
and returns to the issue of terminology, confusion and the misleading and incorrect
conflation of shame and guilt.
Shame: the ingenious quilt
7
The researcher notes that de Hooge, Zeelenberg, and Breugelmans (2010), Stiles
(2008), and Ryan (2008) all put their case using the language of guilt. Ryan (2008),
for instance, speaks with approbation of ―shame/regret‖ (p. 15), apparently regarding
shame and regret as synonymous. However, a person ―regrets‖ doing or not doing
something: it is a guilt concept (Lewis, 1995). Similarly with the arguments of de
Hooge, Zeelenberg, and Breugelmans (2010), and Stiles (2008). This is before even
considering the morally-repugnant notion of manipulation that masquerades as
―motivation‖ (Fossum & Mason, 1986; Stiles, 2008).
B. Brown (2005) argues persuasively for regarding shame as shame, by definition
toxic and never able to be pressed into the service of personal, social or corporate
control. In her critique of the Joyce Brothers opinion piece, ―Shame may not be so bad
after all‖, Brown argues that
promoting good shame is like saying there‘s ―good starvation‖ and ―bad
starvation‖ and that we need to address the obesity epidemic with ―good
starvation.‖ Just like there‘s no such thing as ―good starvation,‖ there‘s no
such thing as ―good shame.‖ The “good shame” that she describes in her
article is actually a combination of guilt and empathy (emphasis added).
Holloway (2005) quotes another prolifically-published shame researcher, June
Tangney, as saying, "Shame is not useful or protective. Guilt is moderately
preventive" (p. 22). Tangney (in Holloway, ibid.), having conducted appropriate
empirical research, goes on to say, contrasting shame and guilt as social responses to
Shame: the ingenious quilt
8
combating crime, ―We know that treatment works in some way. Punishment doesn't
work.‖
Accordingly, when the researcher uses word shame in this study, it carries no positive
connotation, it is not regarded as ―healthy‖, but rather is seen as a debilitating and
pathological affect, for which, nevertheless, hope for treatment and healing continues
to exist.
Shame: the ingenious quilt
9
PART 2: LITERATURE REVIEW
2.1 Introduction
The literature on shame is varied, though broad seams of interest and concern run
through it. Expected topics, within the context of shame, include general discussions
and overviews; eating disorders and related body-image issues; sexual abuse and
abuse within the breadth of that spectrum; and developmental and attachment issues.
Not surprisingly, a considerable intersection, overlap and interaction occurs between
some of these common themes and concerns.
Another significant body of exploration takes in notions of healing shame, with
differing perspectives discussed, assessed or proposed.
Among topics the researcher found less predictable were discussions of the
connection between shame, spirituality and ecclesial institutions2; development of
empirical or evidence-based tools for measuring or evaluating shame; and broadly-
defined ―cultural‖ studies of shame, which included comparisons between
nationalities, student bodies, sports teams, and organisations. The literature also
includes a small number of studies exploring shame from an evolutionary perspective.
Although many articles dealt with shame in a psychotherapeutic setting, none directly
addressed the research question. The researcher did not find this altogether
surprising: the literature tended to focus on particular issues (as above), rather than a
particular therapeutic environment.
2 The subject itself is unsurprising, given the historical propensity of the Church to use shame and guilt
brazenly as mechanisms of control and weapons of mass degradation.
Shame: the ingenious quilt
10
The majority of the literature referenced contained a wealth of empirical data. The
researcher believes that any study of shame and its presentation in therapy would
demand an evidence-based approach because although psychotherapeutic practice
unquestionably has its theoretical underpinnings, whether they be specifically-
focussed (such as CBT or Gestalt), or eclectic, actual praxis necessarily operates
beyond or above those underpinnings. Much of the literature reflected this belief and
involved evidence-gathering as the basis for their studies.
2.2 The literature in detail
2.2.1 Shame in overview
The winter 2003 edition of the journal Social Research focussed entirely on the
―phenomenon of shame‖, to borrow from the title of Agnes Heller‘s (2003, p. 1015)
overview article, Five approaches to the phenomenon of shame. Heller dealt with
shame from the point of view of the disciplines of anthropology, sociology, ethics,
psychology and history. Although her article contains much that is intellectually
engaging, her approach is deliberately philosophical (ibid.), even when she examines
the ―psychological approach‖ to shame (pp. 1024-1027).
Nevertheless, her overview, taken together, highlights several of the confounding
issues of terminology and definition examined in Part 1 of this dissertation. For
instance, Heller (2003, p. 1019) conflates guilt and shame in the following discussion
of the sociological approach:
The bearer of the social triggers of shame is the eye of the Other, the eye of
the community. One is constantly seen whatever one is doing; one is supposed
Shame: the ingenious quilt
11
to be seen. If she carries out all activities according to norms or rules of the
community, she is not ashamed for the Eye approves. However, if she is doing
something that infringes the rules, or at least might be seen as something that
infringes them, the affect of shame conquers or possesses the person.
Whenever the eye of the Other disapproves, the guilty party feels annihilated:
she blushes, bends her head so she cannot see the judgment of the Eye, runs
away or at least feels the urge to disappear or sink into the earth in order not to
be seen. Are you not ashamed? You should be ashamed! You must be
ashamed! Shame on you! chides the adult world to the child who tries not be
ashamed but rather to learn when and where to avoid shame.
Shame, however, involves a person‘s being (Gilbert, 2003; Kurtz, 2007; Nicolosi,
2009; Tangney & Dearing, 2004). The ―bearer of the social triggers of shame‖
(Heller, 2003, p.1019) is the person, not the community. Further, it is not the ―guilty
party‖ who feels ―annihilated‖ (Heller, ibid.) but rather the shamed or shame-based
(Bradshaw, 1988) person who will almost certainly feel the annihilation, the bodily
manifestations of shame such as blushing and the avoidant gaze, and the
imagination‘s metaphor of ―sink[ing] into the earth in order not to be seen‖ (Heller,
2003, p. 1019).
The confounding pronouncement of judgement using the statements Heller quotes –
Are you not ashamed? You should be ashamed! You must be ashamed! Shame on
you! – typically occur in the context of guilt; that is, when a person has done
something (morally) wrong or bad. Consider, for example, the recent case of a Royal
Australian Navy sailor convicted of raping a female colleague while she was sleeping
Shame: the ingenious quilt
12
(Draper, 2011). The Victorian County Court Judge, Michael Tinney, made the
following comments:
"You did as you pleased with her," Judge Tinney said.
He said Calvert held his phone in one hand while penetrating the 18-year-old
with the other, treating her "as no more than an object or a prop".
"This was disgraceful conduct by you, both in penetrating her in those
circumstances and filming it, and became more disgraceful still when you
showed this material to other men," Judge Tinney said.
"You should be ashamed of yourself."
The judge‘s comment, even though it uses a derivative of the word shame, arises from
a judgement of guilt, in other words, something done. Ironically in this case, it is
possible that the assailant, ―who had been a loner growing up, [and] was attracted to
the camaraderie promoted by the defence forces and had joined the navy to make
friends‖ (Draper, ibid.) may well have shame issues that occurred in childhood (Boyd,
2007). If this suspicion proved true, the judge‘s remark, ―You should be ashamed of
yourself,‖ is redundant: the assailant would already be shame-based and that could be
one of the primary psychological factors informing his treatment of a powerless
woman.
Since shame and guilt exercised several researchers, this issue is examined next.
Shame: the ingenious quilt
13
2.2.2 Shame and guilt
As noted in Part 1 and in the previous section (2.2.1), confusion exists between the
concepts of shame and guilt. At one level it is a problem of language and its
limitations. Sabini and Silver (2005, p. 1) highlight this issue in their Target Article
and argue that:
linkages between mental states and emotion terms are more complex than
emotion theorists have thought…[and] there are fewer mental states than there
might seem to be, but…they are related to language and its use in more
complicated ways than had been thought.
In other words, in English, for example, the number of words available to describe
emotion or affect exceeds the number of actual emotions (cf B. Brown, 2008, p. 12;
Tangney, Mashek, and Stuewig, 2005, p. 44).
Sabini and Silver (2005, p. 7) argue that ―shame and guilt are not in general the same,
though they may in particular instances be the same‖ (their emphasis). However,
Tangney, Mashek, and Stuewig (2005, p. 46) conclude that shame, guilt and
embarrassment are distinct, at least to the extent that the ―semantics of emotion seem
to capture meaningful variations along multiple relevant dimensions‖. They reach
their conclusion after referencing a wide and complex range of empirical studies
(Tangney, Mashek, and Stuewig, 2005, p. 45). Other studies support the view that
these distinctions are empirically verifiable and valid (B. Brown, 2008, p. 13;
Tangney & Dearing, 2004, p. 49; and Tangney, Miller, Flicker, & Barlow, 1996, p.
1267).
Shame: the ingenious quilt
14
A question arises, however, about the phenomenological aspects of these differences
(Tangney, Wagner, Hill-Barlow, Marschall, & Gramzow, 1996). Researchers and
theorists typically regard shame as a disorder of the self (Lewis, 1995; 2003;
Morrison, 1987; Reid, Harper, & Anderson, 2009; Tangney, 1991; Tangney, Wagner,
Hill-Barlow, Marschall, & Gramzow, 1996; Tomkins, 1963). This understanding
reflects the greater attention paid to the study of shame, and its differentiation from
guilt, since the first half of the twentieth century: empirical research has demonstrated
that the then-nascent public (shame) versus private (guilt) dichotomy was unhelpful,
inadequate and misleading (Miller, Flicker, & Barlow, 1996; Tangney & Dearing,
2004)).
Shame is commonly described as ―painful‖ (B. Brown, 2008; Felblinger, 2008;
Nathanson, 1987), meaning that when a person experiences a shaming event, whether
deliberately-targeted at the person, or perceived as such, the shame affect activates
both a physiological and psychic response (Cozolino, 2002; Sabini & Silver, 2005).
The descriptive vocabulary of these phenomena is often intense. Terms used include
―annihilated‖ (Heller, 2003, p. 1019; Sorotzkin, 1985), ―excruciating‖ (B. Brown,
2008, p. 5; Felblinger, 2008, p. 237; Kaufman, 1992, p. 9), ―emotionally
overwhelming‖ (B. Brown, 2008, p. 5). Silvan Tomkins (1963, p. 118) had already
discussed the phenomenology of shame using these powerful words: ―…shame is felt
as an inner torment, a sickness of the soul…[the shamed person] feels himself naked,
defeated, alienated, lacking in dignity or worth.‖
Shame: the ingenious quilt
15
That this language is so clearly metaphorical suggests several issues: the intensity of
the shame experience is such that only hyperbolic word pictures can approach an
adequate description of its effect on a person; although research supports the
viewpoints, the descriptors remain at the theoretical level; metaphorical language
itself implies the hiding, covering, avoidance of exposure that is so markedly a feature
of shame. As B. Brown (2010) states, discussing shame during a TEDxHouston Talk,
―No one wants to talk about it, and the less you talk about it, the more you have it.‖
The limitations of Brown‘s twenty-minute public lecture account for the succinctness
of the comment but it reiterates the fully-formed and –researched material in her
earlier work (2008), while other research and theory supports the same view (Hansen,
2006; Kaufman, 1992).
Lewis (1995, p. 34) provided a four-point summary of phenomenological issues. First,
shame exists prior to its inevitably-sudden emergence as a result of the right stimulus.
That is to say, shame will already be internalised in a person without their necessarily
(initially, or pre-therapy) being aware of it, but certain triggers will activate the affect
so that it becomes a feeling, which is how the person will experience the shame.
Wanting to hide, disappear or, in the classically-expressed vernacular, have the
―ground open up and swallow me‖, is the common clue that a person has experienced
a shaming event or trigger. (Heller, 2003; Nathanson, 1987; Nathanson, 1992).
Second, as seen above, shame brings with it an extreme level of discomfort. Lewis
contends that this intensity distinguishes shame from embarrassment and shyness
(Kaufman, 1992; Tangney, Miller, Flicker, & Barlow, 1996). Third, the implication of
the affect, shame, is a generalised sense of defectiveness (B. Brown, 2008; Tomkins,
1963; Young & Klosko, 1994). Fourth, in shame the person becomes both subject and
Shame: the ingenious quilt
16
object, the result of the person being and becoming thoroughly self-focussed
(Kaufman, 1992; Nathanson, 1987; Tomkins, 1963). This suggests one of the reasons
for the shame-based person‘s absence of empathy: they lack the necessary awareness
of the ―other‖ (the object) because of this thoroughgoing focus on the self (B. Brown,
2008; Tangney & Dearing, 2004).
However, one of the singular features of shame is its physiological manifestations,
arguably the most recognisable of which is blushing (Cozolino, 2006; Hansen, 2006;
Heller, 2003; Nathanson, 1987). Other typical indicators of the activation of shame
include variations on avoidance: lowering the head, downcast eyes, covering head and
eyes with a hand as if shielding them from the glare of the sun, ―burying‖ the head in
both hands (Cozolino, 2006; Heller, 2003; Potter-Efron & Potter-Efron, 1989;
Tangney, Mashek, & Stuewig, 2005). Tangney, Miller, Flicker, and Barlow (1996)
also reported heart-rate increases in test subjects who felt shamed.
However, if the affect, shame, gives rise to powerful feelings, and if activated shame
has a physiological expression, how does shame ultimately appear? what actions
might result from a ―shame attack‖ (B. Brown, 2008)? Reid, Harper, & Anderson
(2009) used a version of Nathanson‘s (1992) Compass of Shame Scale (CoSS), which
Elison, Lennon and Pulos (2006), and Elison, Pulos and Lennon (2006) had modified
to account for the ―source of the shaming event‖ (Reid et al, 2009, p. 128). The CoSS
attempts to describe broadly the four ―action tendencies‖ (ibid.) of a shamed person.
In other words, these four ―poles‖ (ibid.) of the Compass suggest likely behaviours
when a person experiences shame.
Shame: the ingenious quilt
17
The first pole is Withdrawal, which, as its designation implies, reflects a shame-
based person‘s tendency to withdraw from confrontation in order to defuse a shaming
event perceived as negative and valid (ibid.). The second pole is Attack Self. Here,
anger is apparent, but directed towards the self, the purpose being to encourage
support from others ―by engaging in self-deprecating comments‖ (ibid.). Attack
Other is the third pole, within which the shamed person‘s anger is aimed outwardly
in order to lessen or remove the pain of feeling shamed. This ―externalisation‖ of
shame often presents as blame, and can include ―rage and verbal or physical abuse
towards others‖ (ibid.). The fourth and final pole, Avoidance, is akin to denial. The
shame is neither admitted nor regarded as valid: the person ―attempts to distract,
dissociate or disconnect the self and others from the painful emotion‖ (ibid.). The
theory suggests that the shamed person, using strategies such as ―humour or
indifference‖, is unconscious of their behaviour (Reid et al, 2009, pp. 128-129).
2.2.3 Shame, attachment and developmental theory
Shame theorists are in large measure agreed that one of the significant sources of
internalised shame comes from a person‘s earliest experiences of life (Bowler, 1997;
Boyd, 2007; Cozolino, 2006; Erikson, 1995; Felblinger, 2008; Nicolosi, 2009).
Cozolino (2006, p. 234) observes that the internalisation of shame occurs at a stage of
life when a person – an infant – is unable to distinguish between ―the action and the
self‖. In other words, the infant experiencing what, from an evolutionary perspective
is the primitive emotion of shame, cannot understand that the shaming action of a
parent or caregiver arises from the infant‘s behaviour, which the caregiver knows is
separate from the infant. As far as the infant is concerned, they and the behaviour that
incurs the shaming event are indistinguishable. This is where the quilt of shame
Shame: the ingenious quilt
18
begins; the undivided landscape of infancy is the cutting table upon which shame is
fashioned.
Inevitably, the literature either alludes or refers directly to the work of Erikson, who
formulated an eight-stage developmental theory that sought to account for a person‘s
psychosocial growth from birth to advanced age (Erikson, 1995; Yahaya, 2006) –
though in Erikson‘s time life expectancy averages were lower than today‘s. Two
stages are of particular importance for shame theorists: the second, early childhood,
18 months to 3 years; and the third, the play age, 3 to 5 years (Harder, 2009; Yahaya,
2006, p. 5).
The second stage – notoriously the age of toilet-training (Harder, 2009) – produces
the psychosocial ―crisis‖ of autonomy versus shame and doubt (Yahaya, 2006, p. 6).
This is the stage during which an infant‘s task is to separate from their mother and
begin exploring their world independently . However, it is also a time of considerable
vulnerability for the infant (Harder, 2009). If parents and caretakers encourage this
exploration the infant will successfully complete the task of gaining autonomy.
However, should parents or caretakers be routinely over-critical or ridicule the
infant‘s attempts at being independent then the infant will feel shamed, and come to
doubt their abilities (Miller, 1987; Yahaya, 2006). Conversely, caretakers‘ refusal to
allow the infant to do anything for themselves will likely create the impression that
they lack confidence in the infant‘s abilities, and again shame will be the result
(Yahaya, 2006).
Shame: the ingenious quilt
19
Stage 3, the play age, carries the label initiative versus guilt (Erikson, 1995; Harder,
2009; Yahaya, 2006, p. 7). This is the time the child begins experimenting and
pretending, using their imagination to explore their understanding of the adult world
(Harder, 2009) and, to use Yahaya‘s (2006, p. 7) delightful and insightful observation
of the child‘s newly-developing capacity to imagine the future, to ―attempt to make
that non-reality a reality‖. The locus of operation has also widened from parents or
caretakers to include other members of the basic family unit (Harder, 2009; Yahaya,
2006). Yahaya (2006) and Harder (2009) both note that Erikson was a Freudian, even
though he focussed more on psychosocial than sexual features. Nevertheless, Erikson
did comment on the Oedipal nature of this stage: an element of conflict arises between
the child and their parents, resolved when the child begins to understand and identify
with their social role (Erikson, 1995; Harder, 2009). Should the parents handle this
task in a harsh or overbearing manner the child will experience guilt (Harder, 2009;
Yahaya, 2006, p. 8). In terms of the debate about shame and guilt, by this stage the
child has separated from the parents and is able to understand their ―transgressions‖ as
―something done‖ rather than as something essentially flawed in their self.
Bowlby (2005) developed a theory of attachment that intersects at many points with
developmental theory (Mills, 2005). According to Mills, he stands in line with object
relations/attachment theorists who have produced a large and influential body of work
on shame: Nathanson, Kaufman, and Schore (ibid.). For instance, Bowlby (2005, pp.
19-20) writes about the affect of parents‘ reactions to a child negotiating what
Erikson, following Freud, would recognise as an Oedipal conflict:
Shame: the ingenious quilt
20
Nothing helps a child more than being able to express hostile and
jealous feelings candidly, directly, and spontaneously, and there is no
parental task more valuable, I believe, than being able to accept with
equanimity such expressions of filial piety as ‗I hate you, mummy‘ or
‗Daddy you‘re a beast‘. By putting up with these outbursts we show
that we are not afraid of hatred and that we are confident it can be
controlled; moreover, we provide for the child the tolerant atmosphere
in which self-control can grow.
Bowlby (2005, p. 20) goes on to discuss the likely outcomes of two common parental
responses that do not mirror this self-control: first, punishment as a means of
behaviour-change and disapproval; and second, shaming, which Bowlby believes
leads to guilt, anxiety and neuroticism in older children and adults. Both responses
result in fear and guilt, and the repression of the child‘s feelings (ibid.). The
researcher believes, however, that if parents can shame their child with statements
―impressing on the child his ingratitude, and indicating the pain, physical and moral,
which his behaviour causes his devoted parents‖ (ibid.; emphases added) then it is
likely that the child has already internalised shame, and these accusations of
ingratitude and pain simply reinforce the child‘s belief that they are a fundamentally
―bad‖ person. In other words, what Bowlby isolates here are shaming statements
(which he recognises) rather than observations of a child‘s ―guilty‖ behaviour.
However, when Bowlby was writing – his monograph trilogy, Attachment and loss,
appeared between 1969 and 1980, and he had published in academic journals prior to
this (Sable, 2004) – serious study of shame was limited, shame and guilt were
Shame: the ingenious quilt
21
considered more or less synonymous (B. Brown, 2008; Lickel, Schmader, Curtis,
Scarnier, & Ames, 2005; Potter-Efron & Potter-Efron, 1989), and distinctions, when
they did occur, were rudimentary, lacking in sophistication and not fully researched
(Tangney, Miller, Flicker, & Barlow, 1996).
What makes attachment and developmental theory important for shame research is the
clinical and research evidence that suggests that a person‘s early-life encounters have
a lasting impact on their subsequent development and in their adult lives and
relationships (Bowlby, 2005; Engel, 2006; Hansen, B., 2006; Marmarosh, Whipple,
Schettler, Pinhas, Wolf, & Sayit, 2009). Marmarosh, Whipple, Schettler, Pinhas,
Wolf, and Sayit (2009, p. 256) review Bowlby‘s concept of internal working models
and his ―secure base‖ theory (ibid.). This ―secure base‖, representing parents or
caregivers, is a reliable place to which the child, separating from these caregivers to
explore their environment, can return, knowing that they will be safe (ibid.). Bowlby
is under no doubts about the working model concept: ―The extent to which such
working models are valid products of a child‘s actual experience over the years or are
distorted versions of such experience is a matter of the greatest importance‖ (Bowlby,
2005, p. 140; emphasis added).
It is not surprising, then, that the literature includes several studies of shame and its
interrelatedness to and with attachment theory. Wei, Shaffer, Young, and Zakalik
(2005, p. 591) produced a study of the relationship between attachment anxiety and
attachment avoidance, on the one hand, and shame, depression and loneliness
(psychological distress), on the other. Using a sample of 299 undergraduates, they
factored ―basic‖ psychological needs satisfaction (autonomy, competence and
Shame: the ingenious quilt
22
relatedness) into their comparisons between attachment style and significance of
distress (Wei et al., 2005, p. 592). They found that attachment avoidance was not
significantly related statistically to shame, depression and loneliness (Wei et al., 2005,
p. 598). However, they did find a significant statistical relationship between the
distressors and attachment anxiety (ibid.). In describing this outcome, they use the
recognisable language of shame (ibid.):
Individuals with high levels of attachment anxiety tend to have a
negative working model of self and are more likely to suppress or be
unaware of their basic psychological needs because they have learned
that these needs are part of what makes them unlovable. [Emphases
added.]
Attachment theory suggests that this is because a person with attachment anxiety has
a negative self-image and a negative view of others (Cozolino, 2006; Wei et al.,
2005). By contrast, the person whose attachment style is avoidant has a positive view
of self and a negative view of others (Cozolino, 2006; Wei et al., 2005). A person‘s
self-image is the key where shame is under consideration (Lewis, 1995; 2003).
In 2003 Sohlberg, Claesson and Birgegard, using a controlled experiment that tested
the effect on subjects of the subliminal message ―Mommy and I are one‖ (Mommy),
reported findings that reiterated attachment theory, stating that the ―data are clearly
compatible with a link between early relationships and adult functioning‖ (p. 344).
Besides the Mommy phrase, they used an intended shaming phrase ―I am completely
isolated‖ (Isolated) alongside a neutral control ―People are walking‖ (People), and
Shame: the ingenious quilt
23
then measured subjects‘ responses (Sohlberg, Claesson, & Birgegard, 2003, p. 339).
Of interest to this research project was the finding that the two control phrases
produced similar results: the intended shaming phrase, Isolated, did not give rise to
remarkably different scores from the neutral People phrase, with the result that the
control group effectively doubled in relationship to the Mommy group (Sohlberg et
al., 2003, p. 344). Where high shame scores did result was within the Mommy group,
in instances where subjects had a poor relationship with their mothers when they were
children (ibid.). This again is consistent with attachment theory (Sohlberg et al., 2003,
pp. 344-345), and shame theory (Engel, 2006; Hansen, 2006; Kaufman, 1992;
Nathanson, 1987).
Similar results were apparent in a longitudinal study Mills, Arbeau, Lall and De
Jaeger (2010) conducted with children initially aged 3 to 4 years, then again at 5 to 7
years, and finally at 7 to 9 years (p. 500). Their findings suggested that both mothers‘
and fathers‘ shaming behaviours were likely to affect the shame-proneness of their
children, and that it was possible to predict with high accuracy the likelihood of
shame-proneness when these children entered the school system (Mills et al., 2010, p.
522). The study also demonstrated gender differences (Mills et al., 2010, p. 521; cf
Osherson & Krugman, 1990). In girls, high mother-shaming behaviour but low father-
shaming produced greater shame-proneness (Mills et al., 2010, pp. 521-522).
However, where both parents were high-shaming, girls tended to exhibit a lower
proneness to shame (Mills et al., 2010, p. 522). The researchers concluded that girls‘
low shame response encouraged both parents to ―use more shaming‖ (ibid.).
Shame: the ingenious quilt
24
However, preschool boys who returned shame responses had shaming fathers, but by
school age boys‘ proneness to shame was associated with high mother shaming
behaviour, though mothers‘ behaviours may be a result of perceiving their sons‘
higher levels of behavioural inhibition as a weakness to be eradicated (ibid.). The
research concluded that ―proneness to shame is associated with a wide range of
psychological symptoms by middle childhood and potentially earlier‖ (Mills et al.,
2010, pp.522-523), suggesting that ―further longitudinal investigation is warranted‖
(Mills et al., 2010, p.523).
Although this study (above) neither mentions nor alludes to attachment theory, the
evidence of parental shaming behaviours as a control mechanism, leading
subsequently to shame-proneness from a developmentally early age (Mills et al.,
2010), supports the kind of ―attachment loss‖ (Bowlby, 2005) that is so much a part of
the shame quilt (Bradshaw, 1988; Engel, 2006; Kaufman, 1992; Nicolosi, 2009;
Potter-Efron & Potter-Efron, 1989).
The parental role was also examined in a study Scarnier, Schmader and Lickel (2009)
undertook with the aim of comparing parent reactions to first, an actual instance of
their child‘s ―worst transgression‖, and second, a fictional ―wrongdoing‖, in which the
presence or absence of an observer acted as a mediating influence (Scarnier,
Schmader, & Lickel, 2009, p. 205). The results were consistence with shame theory
(B. Brown, 2008; Fossum & Mason, 1986; Kaufman, 1992; Nathanson, 1987). When
parents perceived that their child‘s behaviour exposed them (the parents) to the public
gaze, their shame ratings were high (Scarnier et al., 2009, p. 212). Parents‘ anger and
distancing reactions were also more highly-correlated with the high shame scores,
Shame: the ingenious quilt
25
again agreeing with previous research, especially that which suggested a strong
relationship between shame and overtly-expressed hostility (Scarnier et al., 2009, p.
218). However, when parents believed that they had little or no control over their
child‘s behaviour, guilt rated more highly (ibid.). The dénouements of the behaviour-
reaction studies also supported predicted outcomes: high-guilt parent ratings
eventuated in adaptive strategies to attend to the child‘s behaviour; but parents whose
reaction was shame-based or shame-prone exhibited maladaptive strategies, including
harsher punishments meted out to their children, such as physically violent actions
and withdrawal of parental affection (Scarnier et al., 2009, pp. 217-218).
This is an important study because it demonstrates possible links between shame-
proneness in children and their parents. It would be useful to study – especially
longitudinally – the shame-proneness of children with high-shame parents: theoretical
principles suggest that one of the underlying causes of shame in a person is the
experience they have in their family of origin (Fossum & Mason, 1986; Hansen,
2006; Miller, 1987).
Scarnier et al. (2009) speak of maladaptive parent behaviours as a reaction to feeling
shamed. Their assessment is an objectified description of what many would designate
abuse, which is also one of the high-risk indicators for shame-proneness and shame-
based behaviours (Bradshaw, 1988; B. Brown, 2008; Miller, 1987).
2.2.4 Shame and abuse
The word abuse is something of a loaded term; some evidence suggests a cautious
approach to its use, particularly with regard to non-physical contact (NPC) abuse
Shame: the ingenious quilt
26
(MacKinnon, 2008, p. 1). However, in her stakeholder paper for the Australian
Domestic & Family Violence Clearinghouse, MacKinnon (2008, p.2) argues that NPC
abuse ―works insidiously‖, is part of the phenomenology of physical and sexual
abuse, is especially prevalent in ―most forms of child abuse‖, and has ―long-term‖
consequences at least as severe as ―long-term…physical abuse‖.
MacKinnon (2008, pp. 4-8) outlines three major areas in which the effects of
childhood NPC abuse can appear in adults: physical health, mental health, and
relationships. However, the experience of NPC and physical/sexual abuse not
surprisingly has damaging effects for the child (MacKinnon, 2008). MacKinnon
(2008, p. 4) summarises her literature review findings, stating that:
children who are exposed to domestic violence had more health problems,
higher levels of depression, more attention difficulties, higher rates of
internalising and externalising behavioural problems and less social and
cognitive competence than children who were exposed [to domestic violence]
And one of the major consequences of abuse is a prevailing sense of shame
(MacKinnon, 2008). MacKinnon goes on to observe that ―for many, shame is the
most pervasive and debilitating dimension of their lives as adults‖ (2008, p. 6).
Interestingly, she also mentions alexithymia, variously defined as ―the inability to
identify one‘s own feelings‖ (ibid.), ―an inability to experience and communicate
feelings consciously‖ (Mosby‘s medical dictionary, 2009), an ―inability to recognize
or describe one's emotions‖ (Miller-Keane encyclopedia of medicine, nursing and
allied health, 2003). Although he does not use the word alexithymia, Nathanson
Shame: the ingenious quilt
27
(1992) describes a case in which his patient clearly displays alexithymic difficulties.
Nathanson comments: ―The very deadness that characterized Casey‘s verbal output
was a clue to the presence of shame…If you wonder why someone lacks vitality, look
first for nearness to shame‖ (1992, p. 155; emphases added).
However, abuse need not necessarily occur in childhood, nor be prolonged: it may
eventuate as a result of one or a few highly-traumatic incidents, such as rape (Herman,
1992). Whether abuse is a single incident or prolonged over many years, one of the
possible, even likely, outcomes is post-traumatic stress disorder (PTSD) (Harman &
Lee, 2010). In their consideration of the Diagnostic and Statistical Manual of Mental
Disorders, 4th
Edition, Text Revision (DSM-IV-TR), Harman and Lee (2010) argue
for a broadening of the DSM-IV-TR criteria for PTSD, which incorporates ―fear,
helplessness and horror‖ (Harman & Lee, 2010, pp. 13-14) as the standard
determinants. They say that people experiencing PTSD report a wider range of
feelings than fear, helplessness and horror, among them being shame (Harman & Lee,
2010). Their subsequent study supports, to a large extent, their predicted view that
shame and PTSD are substantially related (Harman & Lee, 2010, p. 21). Herman
(1992, pp. 118-119) also called for ―a new concept‖, on the grounds that the definition
of PTSD depended on particular trauma-inducing events, notably war and disaster,
but failed adequately to describe the multiplicity of effects of prolonged abuse.
Nevertheless, Herman (2007) observed, ―shame can be likened to fear in many
respects‖ (p. 5), and the phenomenology of shame is such that the shame-based
person is constantly, however unconsciously, enmeshed in a terrifying world in which
they seek to avoid exposure, the gaze of the other, the revelation of their flawed self
Shame: the ingenious quilt
28
(Bradshaw, 1988; Heller, 2003; Lewis, 1995, 2003; Tomkins, 1963). This may be fear
―after the fact‖ and might be distinguished from fear at the time of a traumatic event,
but from both an evolutionary and neurobiological perspective, primitive survival
instincts are likely the activating principle in both kinds of fear (Badenoch, 2008;
Cozolino, 2006).
As MacKinnon (2008) noted, with regard to non-physical contact abuse, the long-
term consequences are likely to affect adult lives and relationships. Unsurprisingly,
this is no less true where the abuse is sexual and/or physical, with several studies
examining the relationship between shame and sexual/physical abuse (J. Brown,
2004; Buchbinder & Eisikovits, 2003; Farber, Khurgin-Bott, & Feldman, 2009;
Feiring, Simon, & Cleland, 2009; Feiring & Taska, 2005; Rahm, Renck, & Ringsberg,
2006; Valerio & Lepper, 2009). Common themes, apart from shame, are evident in
the research: symptoms of PTSD; relationship and sexual issues; silence and
silencing; objectification; self-blame. However, even these pathologies are
symptomatic of the larger shame canvas (Bradshaw, 1988; Engel, 2006; Hansen,
2006; Kaufman, 1992; Potter-Efron & Potter-Efron, 1989). The other unifying factor
was that all the studies involved women survivors of childhood sexual abuse (CSA).
One study, however, focussed on male sexual abuse survivors (Lisak, 1994). Many of
the men‘s consequential psychic injuries mirrored those of the various samples of
women survivors: anger, fear, helplessness, isolation, legitimacy, loss, negative self-
image, sexual problems, shame and humiliation, and trust issues (Lisak, 1994, pp.
530-544). One notable difference, however, was the extent to which sexual abuse
caused the men to question their sexuality, to ask whether they had homosexual
Shame: the ingenious quilt
29
tendencies, and to raise more generalised issues of masculinity (Lisak, 1994, pp. 534-
539).
Another consequence of physical and sexual abuse is shame associated with body
image in general and eating disorders in particular (Bradshaw, 1988; Engel, 2006;
Fossum & Mason, 1986; Herman, 1992). Although a number of studies examined
shame and eating disorders (Choma, Shove, Busseri, Sadava & Hosker, 2009; Keith,
Gillanders, & Simpson, 2009; Schooler, Ward, Merriwether, & Caruthers, 2005;
Siebold, 2008; Skårderud, 2007), only Skårderud (2007) examined the link with
sexual abuse. Choma et al. (2009), Sadava and Hosker (2009), Keith et al. (2009) and
Schooler et al. (2005) saw shame as related existentially to over-eating, anorexic
tendencies, or body-image, but only Keith et al. (2009, p. 325) suggested that ―this
shame is of a more general nature than simply shame about eating disturbance‖.
Nevertheless, eating disorders are only one of a number of maladaptive responses to
shame and abuse (Engel, 2006; Kaufman, 1992; Skårderud, 2007). The acronyms
FEARS and BAD FEARS (Goodwin et al., 1992, p. 221) succinctly, though perhaps
not exclusively, describes a whole complex of intricately-related symptoms:
―Borderline disorders, Affective disorders, Dissociative symptoms, Fears (anxiety and
other post-traumatic symptoms), Eating disorders, Alcoholism or other substance
abuse, Revictimizations, Somatization disorders and Suicidality usually with
compulsive self-mutilation‖. This was later modified to: ―Borderline, Affective, and
Dissociative disorders; and…Fears and post-traumatic anxiety, Eating problems,
Addictions, Revictimization, and Somatization‖ (Wills & Goodwin, 1996, p. 104).
Shame: the ingenious quilt
30
2.3 Towards a summary and conclusion
As part of its process of discussion and conclusion, the literature almost invariably
points towards ―implications for intervention‖ (Schilling et al., 2007, p. 121),
―implications for practice‖ (MacKinnon, 2008, p. 18), ―clinical implications‖
(Claesson & Sohlberg, 2002, p. 282), or similarly-phrased headings. In other literature
the authors incorporate these ―implications‖ within the body of the work: ―If shame is
one of the primary emotions identified, then this study suggests that it is important for
clinicians to view the reduction of shame as a key factor in the treatment of PTSD
(Harman & Lee, 2010, p. 22).
However, several papers take the treatment of shame as their primary topic, arguing
for modalities that vary from Person-Centred to Cognitive Behavioural therapy.
2.3.1 Treatment and healing of shame
Among specific modalities discussed in the literature is Gestalt Therapy (Carroll, F.,
2009; Erskine, 1995; Resnick, 1997; Wheeler, 1997). Resnick‘s (1997) article is of
particular interest, offering in a manner that is neither dogmatic nor purist a reasoned
critique of (Gestalt) approaches that he believes tend to ―violate Gestalt therapy‘s
phenomenological, nonexpert, and dialogic relational position‖ (p. 269).
Other theorists find value in Cognitive Behavioural therapy (Feiring & Taska, 2005),
Emotion-Focused therapy (Greenberg, 2008; Pascual-Leone & Greenberg, 2007), and
Existential therapy (Goldberg, 1990), with each offering empirical or case study
evidence to support their views. Forgiveness therapy from a feminist perspective
Shame: the ingenious quilt
31
(McKay, Hill, Freedman, & Enright, 2007), and with a psychoanalytical twist
(Lansky, 2009) also enter the therapeutic arena.
Self-forgiveness (Rangganadhan and Todorov, 2010) stands as a link between
forgiveness therapy and several studies exploring the efficacy of self-compassion
(Gilbert, Baldwin, Irons, Baccus, & Palmer, 2006; Gilbert & Irons, 2004; Gilbert &
Proctor, 2006; Neff, 2003). Neff‘s (2003) paper anticipates the arguably-more-fully-
formed theory described in Gilbert et al. (2006), Gilbert and Irons (2004), and Gilbert
and Proctor‘s (2006) work, namely Compassionate Mind Training (CMT).
Gray (2009) argues for a ―person-centred framework‖ in treating clients with alcohol
and other drug (AOD) problems who also exhibit shame issues (p. 1). She observes
that it is especially necessary in situations where the stigma of AOD problems and the
views of colleagues indicate a likelihood of further shaming of the client. Herman
(2007), without specific reference to any particular modality, recommends a
recognisably-person-centred approach, though for slightly different reasons. Her view
incorporates known issues of transference and countertransference (Bromberg, 2001;
Goldberg, 1990; Johnson, 2006; Jordan, 2001) and reiterates what Bromberg (1998;
2001) refers to as ―patience‖ (p. 891; p. 299). For Bromberg (1998; 2001), Goldberg
(1990), Gray (2009), Johnson (2006), and Jordan (2001) a relationship of trust
between client and therapist is a sine qua non of effective treatment – which is never
to deny the same or similar viewpoint among practitioners and clinicians who work in
other modalities.
Shame: the ingenious quilt
32
2.3.2 Concluding overview
The literature on shame is wide and varied. In part this is simply because of the many
different ways shame might express itself, as some of the monographic literature
suggests, for example Nathanson‘s (1987) Many faces of shame, and Middleton-
Moz‘s (1990) Shame and guilt: the masters of disguise. That this review of the
literature is not exhaustive, again reflects the breadth of topics the phenomenology of
shame encompasses. Nevertheless, the researcher has attempted to examine those
areas that are likely to be most prevalent in discussions of shame.
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33
PART 3: METHODOLOGY
3.1 Introduction
This study uses that method of qualitative research which is known as interpretive
phenomenological analysis (IPA) (Smith, 2008; Smith, Flowers, & Larkin, 2009).
Qualitative research is distinct from quantitative studies in obvious enough ways: the
former is concerned with analysing the experience of participants, commonly through
detailed study of verbal interactions to elicit meaning, nuance, and an understanding
of the world as the participant experiences or has experienced it (Smith, 2008; Smith
et al., 2009). Where IPA is the method of choice, the researcher‘s interpretive values
are also acknowledged to be part of the hermeneutical process of producing a rich
account of the data (Biggerstaff & Thompson, 2008; Smith, 2008; Willig, 2001). By
contrast, quantitative research is interested in examining values converted into
numerical form (Smith, 2008). Smith (2008) nevertheless points out that elements of
each form of research can and do overlap: quantitative research, for instance, does
involve interpretation of data, albeit numerical data, and some researchers produce a
narrative based on that data. Similarly, qualitative research may arrive at cause-and-
effect discussions and conclusions as might quantitative approaches (Smith, 2008).
IPA itself, developed specifically for and within the discipline of psychology and now
expanding to cover other behavioural, social and health sciences, is a relatively recent
research method (Smith, 2008; Smith et al., 2009). However, its intellectual roots go
deep, with underpinnings in phenomenology and existentialism, hermeneutics, and
idiography (Buchbinder & Eisikovits, 2003; Smith, 2008).
What, then, are those theoretical underpinnings?
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3.2 Interpretive phenomenological analysis: theoretical underpinnings
3.2.1 Phenomenology
Edmund Husserl (1859-1938) developed phenomenology as a corrective methodology
aimed at an all-encompassing reformation, not simply of psychology, but of all the
intellectual disciplines – arts, physical and social sciences, and humanities (Ashworth,
2008). His critique of self-observational experimentation was the catalyst, but he was
also trying to address fundamental flaws in behaviourism, cognitivism, and positivism
(ibid.).
Husserl‘s contention was that researchers needed to deal with, examine, analyse the
actual phenomena, to ―go back/return to the things themselves‖ (quoted in Ashworth,
2008, p. 11; and Smith et al., 2009, p. 12; inter alia!). What he meant by things was
the conscious experience of an individual, upon which reflection (that is, consciously
thinking about the experience) takes place at a later time (Smith et al., 2009). This
process of intentionality begins with a deliberate setting-aside of assumptions and
things the researcher might take for granted (ibid.). Loftus (2006) points out that
intentionality has the sense of ―paying attention to‖ (p. 108), rather than its vernacular
signification of wanting or planning for something to happen. Husserl called this part
of the process bracketing (Ashworth, 2008), also known as the epoché (Giorgi &
Giorgi, 2008). In other words, the researcher‘s presuppositions, assumptions, taken-
for-granted things are bracketed away so that they do not, as it were, contaminate the
experience of the thing under observation, thus freeing the researcher to concentrate
their efforts on the ―lifeworld‖ of the ―thing‖, the phenomenon (Ashworth, 2008).
Shame: the ingenious quilt
35
What follows in the phenomenological process Husserl devised is a series of
―reductions‖, gathered under a designation he termed ―eidetic reduction‖ (Smith et al.,
2009, p. 14). This is an attempt to get to the core meaning of a phenomenon, the
(eidos) or ―idea‖ or ―essence‖ of a thing (ibid.). The final result should be a
description of what a phenomenon means in the lifeworld, or the ―practical and
emotional features of‖ the phenomenon (ibid.).
Giorgi and Giorgi (2009) point out that although Husserl proposed a variety of
reductions, the one most suited for psychological and related research is what Husserl
termed ―phenomenological psychological reduction‖, which they rename ―scientific
phenomenological reduction‖ (p. 33). The value of this method resides in its viewing
of phenomena as ―presences, not realities‖ (ibid.). Such a viewpoint enables the
researcher to observe the phenomenon as it is, in effect bracketing the whole question
of what ―reality‖ means and epistemological issues such as what constitutes
―knowing‖ (Giorgi & Giorgi, 2009, pp. 33-34).
Giorgi and Giorgi (2009) then describe the four basic steps in conducting this kind of
scientific phenomenological reduction. First, read the description of the phenomenon
being studied, which, in terms of this research project, means listening to the recorded
interview, as well as reading the subsequent transcript of interview (Giorgi & Giorgi,
2009). Second, the researcher carefully re-reads each data sample with a view to
tracking changes and transitions in meaning (ibid.). Giorgi and Giorgi (2009) point
out that ―meaning‖ in this sense is not an objective reality but rather is dependent
upon and uniquely linked to the elicited meaning the data themselves reveal
[emphases added]. The third step involves tracking what Giorgi and Giorgi (2009, pp.
Shame: the ingenious quilt
36
35-46) call the ―transformations‖ that will help broaden what is evident in the data.
This is a process of creating a language that ultimately makes communication of the
findings accessible to another reader, which constitutes the fourth and final step
(Giorgi & Giorgi, 2009). This fourth step involves determining a structure or several
structures, if necessary (ibid.). Giorgi and Giorgi (2009) counsel the researcher not to
―force the data to fit one structure‖ (Giorgi & Giorgi, 2009, p. 46). The final (fourth)
part of the process allows the data to speak on its own terms, but also enables nuances
of general meaning, for instance, using Giorgi and Giorgi‘s (2009) example, the
difference between feeling ―anxiety‖, on the one hand, and feeling ―fearful‖, on the
other (p. 47).
Once the researcher has laboured through these four steps, it is possible to write up
the findings and present them in a form that Giorgi and Giorgi‘s (2009) ―competent
colleague‖ can then read (p. 47). As they observe somewhat laconically, ―Without the
reading of a research report, the entire process becomes practically useless‖ (ibid.).
The phenomenological framework, however, is not solely dependent on Husserl‘s
work (Giorgi & Giorgi, 2009). Husserl‘s one-time student, Martin Heidegger (1889-
1976), posited a shift from Husserl‘s perceived abstractness and developed a
philosophical stance whose main trajectories were ontological and hermeneutical
(Smith et al., 2009). His concern was the question of humankind‘s being in the world,
for which he coined the term Dasein, literally ―there-being‖; at the same time, he
wanted to know how individuals made sense of the world into which they were
―thrown‖, how they created meaning in a world that was pre-existent and contained,
Shame: the ingenious quilt
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in his thinking, no ―given‖ meaning, other than the inter-relatedness humankind
perceived upon discovering their existence, their Dasein (Smith et al., 2009).
Maurice Merleau-Ponty (1908-1961) argued for the importance of humankind‘s
bodily manifestation and their distinctiveness and distinction3 from everything and
everyone else in the world (Smith et al., 2009). Smith et al. (2009) observe, ―My
perception of ‗other‘ always develops from my own embodied perspective,‖ (p. 19).
However, it is a unique viewpoint because each body is unique and perceives the
other in a way that is singularly differentiated from any other‘s perception (ibid.)
Jean-Paul Sartre (1905-1980) also extended aspects of phenomenology, though with
possibly a more existential ―twist‖ (Smith et al., 2009). This is not to say that
Heidegger and Merleau-Ponty did not have an influence on existential thinking, but
Sartre‘s contribution contains a particular nuance that further influences IPA (ibid.).
Sartre‘s viewpoint is succinctly summarised by Smith et al. (2009): ― His famous
expression ‗existence comes before essence‘…indicates that we are always becoming
ourselves, and that the self is not a pre-existing unity to be discovered, but rather an
ongoing project to be unfurled‖ (p. 19). What this leads to, therefore, is an emphasis
on engagement with and in the world as the individual unfurls more of their self
(ibid.). This too is a consequence of becoming rather than being: individuals are free
to make choices as they engage the world in the process of their unfurling (ibid.). In
all these respects, absence (nothingness) is of equal significance to presence (ibid.).
3 Interestingly, medical science tends to confirm this perspective: every body, literally, is different. Treatment,
especially pharmacological treatment, proceeds, not on the basis of ubiquity and universality, but in terms of probabilities. Therefore, for any given pathology, only x% of patients will benefit, while it is likely that y% will not. The effectiveness of treatment becomes increasingly complex when “side-effects” are accounted for.
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In summary, Husserl gives IPA the notion of phenomena and their importance as the
primary ground of research. Husserl enjoins the researcher to ―return to the things
themselves‖. Heidegger thought this may be too theoretical and advocated a view of
humankind being in the world, asking how their ―lifeworld‖ contributed to mean-
making as individuals came to realise their relationship with their world. IPA
recognises that interrelatedness is an important factor in the research and analysis of
the individual‘s lifeworld. For Merleau-Ponty, the important aspect of being in the
world was humankind‘s embodiment: human beings are bodies in relationship with
one another and the world around them. But each body is distinct and unique, thus
bequeathing IPA the task of analysing each participant‘s data on its own terms, not as
evidence of generalisability, but as a singular statement based on that individual‘s
lifeworld, whatever might be their relationship with an other or the things around
them. Sartre‘s view that the individual is becoming rather than already known in their
entirety as a being, and is engaged in the world, in embodied relationship with others,
present or absent, informs IPA‘s analysis of the influence of others on the
participant‘s lifeworld.
3.2.2 Hermeneutics
Hermeneutics preceded phenomenology, and arose from a concern with establishing a
sound basis for interpreting scriptural texts (Smith et al., 2009). Among the influential
thinkers on hermeneutics, the ―theory of interpretation‖ (Smith et al. 2009, p. 21), was
Friedrich Schleiermacher (1768-1834), whose position on hermeneutics was that texts
are creations that both the writer‘s ―linguistic community‖ and the writer themselves
influence (Smith et al., 2009, p. 22). He believed that the reader was able to interpret
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the text, provided they were mindful of contextual issues significant for that text
(ibid.).
Heidegger also contributed to hermeneutical thinking and produced two influential
ideas for IPA (Smith et al., 2009). The first is the view of Dasein, the person being
thrown into the world and having to make meaning from their lifeworld (Ashworth,
2008; Smith et al., 2009). Second, Smith et al. (2009) argue that Heidegger‘s
phenomenology questions the possibility of bracketing preconceived ideas entirely,
because those preconceptions may not be evident until the researcher begins the
analytical work [emphasis added].
The third hermeneutical thinker whose work has influenced IPA is Hans-Georg
Gadamer (1900-2002). In his dialogue with Heidegger‘s notion of interpretation and
preconceptions, Gadamer argued that the process of interpretation could effectively be
cyclical in that the phenomenon in question can influence the interpretation, which
can reveal the preconceptions, which can subsequently have the effect of impacting
upon the (new, next, revised) interpretation (Smith et al., 2009). Gadamer‘s dialogue
with Schleiermacher saw him disagreeing with the latter‘s assertion that it was
possible to know the author and the author‘s intention by studying the author‘s text,
contending instead that interpretation happens in the present moment and it is in the
present moment that anything learned from the text applies (Smith et al., 2009).
A final consideration on the topic of hermeneutics is the hermeneutic circle, an
approach that uses a reflexive relationship: ―part‖ and ―whole‖ are understood with
reference to each other (Smith et al., 2009). This accords with IPA‘s iterative
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approach, in which the researcher ―move[s] back and forth through a range of
different ways of thinking about the data‖ (Smith et al., 2009, p. 28).
3.2.3 Idiography
The idiographic4 approach is about uniqueness and particularity (Ashworth, 2008).
Gordon Willard Allport (1897-1967) expounded the principles of idiography as a
corrective to a psychology that seemed uninterested in the individual, seeing them
only in relation to general laws that science had the task of revealing (ibid.). This
―nomothetic‖5 approach fails to account for the unique and particular perspective each
individual might potentially offer (ibid.). IPA‘s method of examining the particular
phenomenon in detail, and also its determination to focus on the particular insights of
particular participants, makes idiography especially suitable as a theoretical base
(ibid.).
A crucial implication of idiographic particularity is that it allows for small sample
sizes (Ashworth, 2008). Unlike its nomothetic counterpart, whose concern is
revelation and explication of general laws and therefore requires increasingly larger
sample sizes for accurate and legitimate outcomes (Neuman, 2006), an
idiographically-informed IPA project can achieve valid results with as few as one
participant (Smith & Osborn, 2008; Smith et al., 2009).
Ultimately, IPA is not seeking to draw universalising conclusions in the same manner
as quantitative analyses might (Yardley, 2008). However, with its concern to elicit
rich, ―thick‖ descriptions of particular phenomena, IPA remains hopeful that those
4 Greek (idios), one’s own, peculiar, hence by extension, particular
5 Greek nomos law.
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descriptive narratives may produce results that support ― ‗theoretical‘, ‗vertical‘ or
‗logical‘ rather than statistical generalizations‖ (Yardley, 2008, p. 238).
3.3 Method
This section, following the suggestions of Smith et al. (2009), outlines the various
steps involved in selecting participants, describing the participants, description of the
data collection instrument, the interview process and its particulars, and the ―sequence
of analysis‖ (p. 112).
3.3.1 The sample
The researcher decided on a sample of four participants, chosen in the first instance
on the basis of broad homogeneity of profession (Smith et al., 2009).
The researcher initially contacted the Secretary of the Psychotherapists and
Counsellors Association of Western Australia (PACAWA), explaining the nature of
the study and asking if PACAWA members could be canvassed to determine whether
there were any interest in participating in the project. The Secretary‘s advice was to
consult the Member Directory and contact members directly, which is how the
researcher selected two of the eventual participants.
The other two sample members were chosen on the basis of informal word-of-mouth
recommendations.
The researcher‘s belief was that four participants would offer a good balance of
perspectives: more than four might have become too unwieldy a number and might
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42
have affected the subsequent analysis of data in a deleterious manner, given
circumscribed time constraints. Similarly, fewer than four participants may not have
provided sufficient breadth of viewpoint and experience with regard to the research
question.
Prospective participants were listed with contact details (typically a phone number,
but sometimes an email address) and the actual process of selection involved
contacting these prospects by phone. Several were unavailable and did not respond to
the message the researcher left on their answering machines. When the researcher was
able to speak with a prospective participant, he explained who he was (a Master of
Counselling student at the Fremantle campus of the University of Notre Dame,
Australia), and the nature and aims of the project. The researcher asked whether the
prospective participant would be willing to be interviewed and he explained how the
interview would proceed.
All of the prospects to whom the researcher spoke directly agreed to participate.
Researcher and participant then negotiated a mutually-agreeable date, time and place
for the interview to take place.
3.3.2 The participants
As Table 1 illustrates, the sample consisted of two female and two male therapists.
Two drew clients from the general population, that is to say, their practice did not, at
the time of the interviews, specialise in a particular population. However, two of the
therapists had specific areas of interest: Sexual abuse, and Domestic violence.
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Table 1: Participants
PARTICIPANT PROFESSION PROFESSIONAL
POPULATION
Male Psychoanalyst General population
Female Clinical Psychologist Sexual abuse
Male Counsellor/Educator Domestic violence
Female Occupational Therapist, Counsellor and
Psychotherapist General population
In terms of sex and professional population, the choice of participants seemed to offer
a balance of perspectives. Shame theory suggests that abuse of any kind is likely to
leave a legacy of shame proneness or lie behind shame-based pathologies (Bradshaw,
1988; J. Brown, 2004; Buchbinder & Eisikovits, 2003; Engel, 2006; Farber, Khurgin-
Bott, & Feldman, 2009), but the researcher was also interested in what therapists with
a general caseload might experience with their clients. Although gender may be an
issue in therapeutic interactions, results are ambiguous: the researcher did not
consider this a major limiting factor (Blow, Sprenkle, & Davis, 2007; Creamer &
Liddle, 2005; Miller & Ivey, 2006).
The participants also possessed varying levels of experience although all were
tertiary-trained and in professional practice. With the caveat that such figures may be
misleading when considering efficacy, the experiential range was five years‘ to more
than forty years‘ experience as therapists. For the purposes of this study, the range
seemed a mix, providing good variety within the homogeneity.
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3.3.3 The data collection instrument – interview schedule
The researcher followed the outline given in Smith and Osborn (2008), planning to
collect data by means of semi-structured interviews (p. 58). The advantage of the
semi-structured interview approach is that it has at its base a flexible data collection
instrument – in this case an interview schedule (Appendix C) that consisted of seven
separate questions related to the research aims.
Flexibility of approach was the key consideration. The interview schedule would
serve as a starting point and be available as ―back-up‖ if a participant seemed to lack
anything further to impart. However, the research plan was to ask the initial question
or questions and then follow the train of thought of the participant, allowing them to
reveal their lifeworld in their own words, paying attention to their own experience of
the issue at hand, in this case, shame and how shame related to the presenting issues
of their clients.
To this end, the researcher had at his disposal ―adjunct‖ questions in the event that a
participant spoke of an issue that seemed especially relevant or revelatory. Such
questions included, but were not limited to: ―Could you tell me more about…?‖; ―You
mentioned… Can you explain what you mean by…?‖; ―That‘s an interesting
distinction. How are you making that distinction?‖ These adjunct questions were not
written down, but rather remained available to the researcher for use as and when he
considered them useful to employ.
The researcher particularly wanted to avoid ―leading‖ questions, or questions that
might allow the participant to provide answers or responses the participant thought the
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45
researcher wanted to hear. This is another advantage of the semi-structured interview
technique. The in-built flexibility places a certain responsibility on the participant to
offer their own lifeworld responses rather than bespoke or crafted answers that don‘t
necessarily carry that lifeworld authenticity. But it is a shared responsibility: the
researcher also has to encourage the participant to speak about their lifeworld rather
than an imaginary or inauthentic one.
The questions in the interview schedule were deliberately constructed as ―open‖, as
opposed to ―closed‖, questions. In other words, where the researcher asked a schedule
question, the participant would have to provide a considered answer, not the ―Yes‖ or
―No‖ response closed questions commonly elicit. Again, it seemed more likely that
the participant would speak of and from their lifeworld if they were responding to a
question that required some consideration of their own experience.
3.3.4 Interview particulars
The semi-structured interviews lasted from 48 minutes (the shortest) to 56 minutes
(the longest). Each participant was informed at the initial contact stage that the
interviews would be recorded. Each interview was recorded using a Philips Voice
Tracker digital voice recorder. The researcher double-checked before each interview
began that the participant was agreeable to the recording of the interview. All assented
without expressing concern.
Each participant was given an Information Sheet (Appendix B) before the interview,
which provided details of the interview process and ethical issues such as
confidentiality, secure storage of data gathered, and appropriate channels of complaint
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46
or grievance should such issues arise. The Information Sheet also confirmed that ―the
Human Research Ethics Committee of the University of Notre Dame Australia has
approved the study‖.
Each participant received and signed the appropriate Consent Form (Appendix A).
Also prior to commencement of each interview, the researcher sought the participant‘s
permission to take hand-written notes. Again, each participant assented without
expressing concern.
Once the interviews were recorded, the resulting MP3 file was copied onto the
researcher‘s computer and filed in a secure folder. Each digital file was given a
filename using the formula SI n YYYYMMDD, where SI is an abbreviation for
Shame Interview, n is the chronological number of the interview, and YYYYMMDD
signifies the date6: year (in full); month; and day. No identifying information was
included, either on the filename or the notes.
Once recorded, interviews were sent to an off-site transcription service in the eastern
states whose practice is dedicated to the transcription of postgraduate work of the kind
in which the researcher was engaged. The transcription service is fully conversant
with issues of confidentiality. All digital files and subsequent transcriptions are
destroyed after completion of each assignment.
Transcriptions were filed with the relevant digital recordings.
6 The YYYYMMDD formula is an internationally-recognised format that allows ease of sorting large volumes of
date-significant data.
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The interview technique is best described as analogous to a person-centred therapy
(PCT) session. The interviewer adopted a stance of unconditional positive regard
towards each participant, and used typical PCT minimal encouragers to convey his
interest and desire to hear more. The adjunct questions mentioned earlier were
phrased in a respectful, non-demanding way. Attentive listening was a key component
of each interview, as was observation of non-verbal cues, although the researcher did
not challenge or confront, as perhaps he might in a therapeutic setting.
3.3.5 Sequence of analysis
While waiting for the transcripts the researcher began the process of analysing the
interviews by listening to the interviews several times. The interviews were also
burned onto unidentified CDs and the researcher continued the listening process while
driving. This part of the analysis gave the researcher a better understanding of the way
each participant spoke, and presented and organised their information and responses.
When the transcripts were available the researcher read and re-read each transcript in
turn, again with a view to eliciting a ―feel‖ for the each participant‘s style of
communication, as well as, at this stage, a casual mental noting of discernible themes.
The task of analysis-in-earnest began as each transcript returned. Received as a digital
file, the transcript was then printed so that the process of coding could begin. The
audio-immersion period described above was invaluable when it came to reading and
re-reading the transcripts themselves because the words-on-paper allowed a ―fixed‖
sense of the interview to begin to materialise, in most cases confirming the
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48
researcher‘s initial impressions, but also providing additional insights or clarifying
points of ambiguity. All outcomes proved helpful.
Themes were gleaned during the reading process and noted on systems cards. This
was done for each interview transcript. In this part of the analysis the participant‘s
words provided the language.
However, a comparison/contrast analysis of initial themes allowed for combination
and conflation of participant themes into a more generalised language that would
make subsequent communication of the findings more accessible for other readers. At
this stage the researcher began colouring in the transcripts using fluoro highlighter
pens so that the generalised, conflated themes could be seen more readily on the page.
In this latter part of the analytical process the researcher‘s interpretations of each
participant‘s lifeworld was most clearly in focus. As certainly as any rendering of one
language into another, the process of generalising participant concepts required
interpretive decisions. For instance, several participants spoke, some at length, some
with particular reference to theorists, about developmental issues relating to shame.
The researcher had to decide how to group these (and other, similar) trajectories. Was
this an issue relating to General shame theory? Perhaps the most straightforward
thematic group would be Developmental issues? The researcher‘s final decision was
to use the phrase Foundational issues, partly because it suggested the early-stage
locus of shame pathology, encompassing developmental theory, and partly because
foundational conveyed that sense more accessibly than the arguably more technical
developmental.
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PART 4: FINDINGS
4.1 Introduction
As described in Part 3, the analysis of the participant interviews reduced iteratively to
a number of key themes, with a number of sub-themes also evident. Table 2 sets these
out for ease of viewing.
Table 2: Themes and sub-themes
THEME SUB-THEME
Foundational issues Developmental issues
Attachment
Shame theory Cultural issues
Gender issues
Guilt
Presenting issues Child sexual abuse (CSA)
Domestic violence (DV)
Therapy Psychodynamic
Eclectic
Narrative
4.2 Thematic narrative
4.2.1 Foundational issues
Once upon a time and a very good time it was there was a moocow coming down along the
road and this moocow that was coming down along the road met a nicens little boy named
baby tuckoo.
James Joyce
A portrait of the artist as a young man
It is a sad and tragic thing that not all childhoods contain memories as sublime as
Stephen Dedalus‘s seem to have been as Joyce‘s novel begins. Shame theory suggests
that a strong link is evident between shame and ruptured attachment bonds (Bowlby,
2005; Engel, 2006; Hansen, B., 2006; Marmarosh, Whipple, Schettler, Pinhas, Wolf,
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50
& Sayit, 2009). As one participant expressed the issue, with a forthright absence of
ambiguity:
Well in my experience, there‘s a very clear link between childhood
victimisation and shame and the crimes they subsequently commit. [SI 2]
Although at this point the participant is thinking about a serious and traumatic
shattering of attachment through childhood sexual abuse, they go on to say,
There‘s no, like, I‘m wanting to make perhaps a distinction that even the
shame that people subjectively experience in adulthood, to my mind, comes
from their childhood emotion of shame. [SI 2]
and,
And so it‘s integral really that there is a relationship [between childhood
shame and offending] and it‘s key. But it might well be the childhood one, not
the adult one. [SI 2]
One participant spoke in more general terms about the influence of childhood
experience on shame. As they explained:
Um, you see, one of the pernicious elements of shame is that it—because it,
the foundation is established usually very early on in the client‘s life, in their
childhood, what children experience they tend to see as natural. They tend to
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51
see that as, you know, ―The reason this person looks at me in this way and
treats me in this way is because I deserve it,‖ or, ―It is just the way things are.‖
You know, there is a truth in it and therefore they won‘t—they tend not to use
the word shame because that‘s a word that starts to explain what has happened
to them. In other words, for the client, it is just what it is. It‘s that they feel bad
about themselves and that‘s what they are more inclined to say. They are
more inclined to say things like, ―I‘m hopeless. I‘m lazy.‖ They might say, ―I
feel really bad about myself.‖ Or they might say, ―I hate myself.‖ They might
say, ―I‘ve done very bad things.‖ But they‘ll tend not to use the word shame
because that is a word that starts to explain something. [SI 1]
In this instance the participant‘s observations overlap with the theme of Presenting
issues, but the key thinking touches on both attachment loss and developmental
theory. This participant is explaining in theoretical terms how the affect, shame, can
become internalised in childhood and cause problems in adulthood. Erikson‘s
developmental theory understands this as a failure adequately to negotiate the second-
stage ―task‖, autonomy versus shame and doubt (Erikson, 1995). Such a failure might
lie behind some of the example statements the participant offered: ― ‗I‘m hopeless.
I‘m lazy.‘ ‗I feel really bad about myself.‘ ‖ These are indicators of the feelings of
worthlessness and powerlessness that often accompany shame, or which shame-based
people might articulate about themselves.
This participant also made some insightful comments about the role and significance
of imagination in the internalisation of shame, a perspective that the researcher had
not previously encountered.
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52
The participant‘s initial observation here was,
You know, human beings are separate. Their interiors cannot really infect each
other but they do so through the work of the imagination. And so, let‘s say this
now about shame: shame has an imaginative quality as well. Shame only
works—I can only shame a person, a person can only be shamed if they
believe or imagine that a message that they are receiving is one that is really
going to deeply be critical of them. [SI 1]
The remainder of the exchange is set down as it happened, continuing from the
statement recorded above:
Interviewer: Yes.
Participant: In other words they have to engage with it at the level of
imagination.
Interviewer: Hm.
Participant: They have to say, well, this is right, ―I am filthy,‖ or ―I am
dirty,‖ or ―I am a failure,‖ or ―I am lazy‖. So imaginatively,
they have to connect with a message they are getting. Otherwise
the message is impotent. It will have no effect on them.
Interviewer: Yeah.
Participant: So what we want to do in therapy is we want to disarm the
affect of the imagination. We want to take out the imaginative,
the imaginary element of that by speaking about it. We want to
make it, we want to turn it into words, we want to turn it into
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53
sentences and language so that we can actually be clear about
what‘s going on. [SI 1]
A little in the interview the following exchange added to the participant‘s viewpoint:
Participant: Imagination can play havoc and so ...
Interviewer: Well, yes.
Participant: ... as far as children are concerned, when parents don‘t speak
and when parents remain silent and convey subtle messages it‘s
the child‘s imagination that then goes to work on that and starts
to turn it into something that will be eventually pathological for
them. [SI 1]
In this more concrete observation the participant comments upon the interplay
between parents (or caregivers) who shame, and the manner in which a child might,
through the imagination, create a self-injuring psychic wound. This is an early
dynamic, which means that
It is difficult to work with shame. It‘s a very sticky—because the foundations
of it are laid so early in a person‘s experience it‘s very difficult to move…
[SI 1]
However, it may be that the foundation stone of shame precedes birth, and is part of
the child‘s development in the womb. As another participant commented:
Shame: the ingenious quilt
54
I think it is we are hard wired as a group species, er, and I think shame is
around belonging to the group, to the clan, or to the immediate—having an
immediate other, so I think shame is hard wired into our, um, our way of
attaching and bonding. [SI 4]
This is essentially a neurological perspective and may suggest that human beings are
more disposed or potentially vulnerable to shame and shaming than previously
thought.
4.2.2 Shame theory
I wouldn’t want to belong to a club that would have me as a member.
Groucho Marx
All of the participants spoke about shame from theoretical viewpoints during the
course of the interviews. This is not to say that theory was the primary concern of any
participant, but rather suggests that they all were conversant with significant
theoretical issues underpinning their preferred modality and practice.
The researcher identified three sub-themes:
Cultural issues
Gender issues
Guilt – as a contrasting feeling to shame, and possibly also a confusion with
shame
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55
One participant mentioned the phenomenological manifestations of shame,
contrasting shame with guilt:
I tend to think of shame as, in many ways, I distinguish it from guilt in terms
of being a visual, having a visual element. Someone who is suffering from
shame is suffering from a notion to do with being seen in a certain way. So,
very often shame has much more marked physical symptoms than what we
might think of as guilt. [SI 1]
This is very much at the core of shame. It manifests in the body, causing not only the
intense emotional pain that is so often described, but also a somatic response, perhaps
most notoriously blushing, both of which phenomena can give rise to a desperation to
hide, cover up, seek to disappear (Cozolino, 2006; Heller, 2003; Tangney, Mashek, &
Stuewig, 2005).
The participant in this instance provided two cogent examples of shame embodiment:
Participant: So whereas a person might be operating perfectly normally in
the world with a burden of guilt, what you will see with
someone who is carrying a huge burden of shame, I notice you
use the phrase ‗toxic shame‘ in your introduction, um, this
person will very often just display a physical symptom that
shows that they are struggling with being seen physically and
experiencing a shame around that, that physical, er, their
physical being as it exists in the eyes of somebody else. And so,
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56
what I‘m trying to say is if someone is suffering from toxic
shame they will imagine that somebody is looking at them all
the time and making a detrimental judgment of them and that
this will display itself in their bodies in some way.
Interviewer: Could you give an example of how ...
Participant: I‘ll give two examples. A client who grew up in a very austere,
Calvinist household which didn‘t allow for any expressions of
joy or warmth or affection and any attempt to do any of these
things would have been severely punished and criticised. She
now suffers from an inability to move her body freely. She
walks stiffly. She can‘t swing her arms by her side. She is
unable to dance. Her body is in a way, has been made rigid as
though she is still under observation, still under surveillance
from her father and that she feels her body to be potentially an
object of shame should she express anything joyful or remotely
sensuous or anything of that nature. Another example of a
physical manifestation of a burden of shame would be to do
with skin afflictions and so clients that have skin - problems
with their skin, and er, because the skin is the surface upon
which the gaze of other people lands. So, coming back to this
idea of someone suffering from shame feels they are being
looked at with criticism and with judgement very often you‘ll
see skin problems that I think of as a psychosomatic
manifestation of their shame burden. [SI 1]
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57
Sometimes, however, the person doing the looking and putative judging is not an
‗other‘ but they themselves.
Participant: The word shame is rarely used actually, when I think about it,
hm. What is apparent is what this particular person would say
er, when she looked in the mirror at herself.
Interviewer: Hm, yeah, okay.
Participant: ―Bitch, bitch, bitch, stupid, stupid, stupid‖. The other
manifestation of it Al, was um, my interest is narrative therapy,
that‘s my, my passion if you like, and um, what would happen
with this person; her sense of worthlessness, she would come
into a session, postpone the next one, make another
appointment, then bring a friend and I, at the time, I thought
why had she brought a friend, then it made sense. She wants to
come, so to overcome that sense of worthlessness she would get
a friend to be with her so she wouldn‘t let her friend down
Interviewer: Hm, right, yeah.
Participant: And on other occasions she would um, say, ―I‘ve only come for
five minutes ‗cause I‘m waste—I‘m wasting your time, I‘m
sure there are better things for you to do with your time,‖ so
that sense of that, but at the same time there was a sense of her,
something she did want and that struggle between the two and
er, she‘s overcome that now. But that was that sense, of yeah,
worthlessness. And we eventually called it that. We called it
self-hate which one of the consequences was that sense of
worthlessness. [SI 3]
Shame: the ingenious quilt
58
Several of the observed and noted manifestations of shame are present in this excerpt.
The overwhelming sense of worthlessness, chained rather than simply allied to the
self-hate, expressed as vituperative loathing as the client screams at herself (or her
Self) reflected from the mirror, the insistently self-dismissive monologue, ―I‘ve only
come for five minutes ‗cause I‘m waste—I‘m wasting your time, I‘m sure there are
better things for you to do with your time‖, all accord with shame theory (Engel,
2006; Lewis, 1995; Lewis, 2003).
Sometimes, however, focussing on negative self-talk can be turned around to become
a therapy tool:
Like if a person is in a state about something in the present then I will work in
the present as well and not always go back um, to kind of um, unveil their
negative self talk or say, for example, in talking with somebody about feeling
shame in the present, I might go back and ask them to think about what‘s
triggered it. What is the activating event and what‘s their way of talking about
it. And, some of the ways that trigger the shame are, ―I should‘ve known
better,‖ or ―There‘s something wrong with me that I didn‘t do this,‖ or ―This
person has found me out‖. You know, so all sorts of self talk ... [SI 2]
The participant continued:
... can lead to the experiential, um, the feeling state of shames or um,
depression and to unpack that and to get them to be able to exercise control
Shame: the ingenious quilt
59
over it we go and re-visit that self-talk and say, it would‘ve been—would‘ve
been more helpful if I‘d done something different but I, you know, I, it‘s not
the end of the world that I didn‘t. You know, so, challenging irrational beliefs
is another one I use. Teaching people how to be assertive rather than
aggressive ... [SI 2]
As already noted with regard to attachment theory, a severing or rupture of the
attachment bond between parent/caregiver and child can have shaming consequences.
One participant considered this relational aspect to be crucial, not only in terms of
childhood attachment, but throughout the lifespan:
Um, but you know, shame can occur without any external involvement. Er, we
know that shame can happen in a small child just in a realisation that you‘ve
done something outside of the group, or sometimes shame can occur simply
because you‘re exposing something. No one‘s behaved badly or even noticed,
but one‘s self noticing gives rise to shame in children. I think that continues
throughout life. So it‘s one of those hidden, er, systems that catch people
unaware and instinctively we will do anything to avoid it. It‘s the worst feeling
you get because it knocks out your existence relationally with others. [SI 4]
Two of the participants mentioned cultural issues with regard to shame. One used
culture to illustrate the general difference between a shame-based and a guilt-based
culture:
Shame: the ingenious quilt
60
Well, yes, I don‘t—well, yes, it is interesting and I‘ve—but I think I‘ve been
fascinated by the studies of different cultures and the shame-cultures versus
the guilt-cultures, you know, for example there is some writing about – I can‘t
remember the reference now but about Aboriginal culture being a shame-
based culture and say something like Judaism coming from a guilt-based so
that you have to have the kind of legal and of breaking the law concept before
you can actually have guilt. [SI 2]
The distinction is useful because developmentally shame precedes guilt in Erikson‘s
theory, which suggests that to have a working concept of guilt and law-breaking a
child must be aware of the existence of others. By contrast, the shame-based child has
been driven inwards because their attempts to explore independence have drawn
shaming or otherwise abusing reactions from others, most notably parents or
caregivers. The child‘s striving for autonomy has therefore been forestalled and
prevented, and because the child is only very imperfectly able to see themself as
separate from parent/caregiver, they come to believe and internalise shaming
reactions as an accurate reflection of who they are.
For the second participant who spoke of cultural issues in relation to shame theory,
the focus was more specific, offering a contrast between how aboriginal society had
once viewed shame, in comparison with the western perspective:
But the version it takes—it‘s interesting with Aboriginal people when I
worked I did the um, trained group of, two groups of Aboriginal women in
counselling ten years ago, um, and it was very interesting working with that
Shame: the ingenious quilt
61
culture because I did discover shame operates in both cultures, but their
version of shame is quite a different qualitative experience to western shame.
[SI 4]
and,
So, in Aboriginal, shame is warmer, it‘s not cold like it is in Western culture.
[SI 4]
and,
So in western culture it‘s like saying, ―You‘ve gone over the line. You don‘t
belong with us‖. With Aboriginal culture it‘s like ―You‘re going over the line,
heh, come over here,‖ with a laugh. [SI 4]
Aboriginal culture valued belonging and relationship as much as western societies but
shame was used to restore broken relationships.
They understand shame is about going outside and er, loosing yourself out in a
group. Well, I suppose if you develop that out in the desert, there‘s nowhere
for the person to go. You can‘t exist on your own so it‘s like, ―Heh don‘t do
that dumb thing to yourself. Come over here. You belong with us‖. So it‘s
actually the reverse, ―You belong with us‖. Versus in our culture it is ―You
don‘t belong with us. You‘re nothing, you‘re an object, you‘re not one of us‖.
[SI 4]
Shame: the ingenious quilt
62
Unfortunately a negative transformation has since occurred:
Yeah, I mean they have, they have the critic, they have a lot of guilt, they
suffer from all those things and of course their culture now is very shame-
based because of the abuse, generations of abuse and it‘s now internalised;
operating internally. [SI 4]
This conversation about culture widened eventually to consider a world of shifting
lifestyle upon which modern technology was also impinging. Still talking about
aboriginal culture, however, the participant spoke about the shame that aboriginal
men feel when they are unemployed:
Participant: And that, it‘s interesting that a lot of violence comes up around
unemployment; times of unemployment where men don‘t have
a source of self-esteem or belonging and so they attack
whatever is close.
Interviewer: Yes, are we talking simply about the breadwinner notion?
Participant: Er, is it more the breadwinner? It‘s actually having a place in
the world.
Interviewer: Hm, mm.
Participant: It‘s much more than earning money.
Interviewer: Oh yeah, yeah.
Participant: It‘s about one‘s masculine identity I think. I think that‘s why
the Aboriginal men have struggled so severely and not lived
very long.
Shame: the ingenious quilt
63
Interviewer: Yes.
Participant: Because they haven‘t found a place in the world. It‘s not just ―I
haven‘t got a job‖. But there‘s no purposeful, meaningful
engagement that betters the group or betters the clan or the
family, er, it‘s not just about money because they don‘t care
about money just to some degree and getting welfare keeps the
food coming so that doesn‘t solve it .
Interviewer: Hm, yeah, yeah so there‘s a sense of real displacement ...
Participant: Yeah. [SI 4]
Shame abounds in the absence of pride about one‘s place in one‘s society. When that
sense of place and therefore purpose is unavailable, it is not surprising that anger and
violence become unhealthy, unhelpful means of dulling the agony of shame. Shame
theory would confirm the relationship between anger, violence and shame (Bradshaw,
1987; Engel, 2006; Hansen, 2006). The participant had this to say:
Participant: Well it‘s loss of context in which they can um, be fruitful and
achieve and feel proud, pride, so I think the other side of shame
is proud, pride is the other side of shame. Feeling proud of
oneself. Proud of one‘s contribution, proud of one‘s place,
proud of one‘s clan or group. Identified with those things and
those people and a sense of goodness arises inside.
Interviewer: Hm, mm.
Participant: So maybe that‘s partly the, um, the kind of growing that needs
to happen. People finding some sense of worth in who they are
Shame: the ingenious quilt
64
just as they are and to find expression by that worth. So it‘s not
enough just to feel it but it actually needs to be expressed in
life. [SI 4]
From what this participant had said, men could feel the effects of shame during times
of unemployment. But where and how did women fit into shame theory? Another
participant, when the researcher asked about gender differences, responded:
Interviewer: Yes. Getting back to that, the gender things, you mentioned that
with men they might usually present as suicidal whereas
women might present as disempowered.
Participant: Hm.
Interviewer: Are there other differences?
Participant: In gender issues?
Interviewer: In gender issues, yes.
Participant: Hm. No, not really. There‘s more similarities between both men
and women apart from that. Like, um, the issue of being a
victim of life, you know, a victim of all sorts of things. Um,
that‘s common to both men and women. Like the
disempowerment. Like I think—I guess I use the suicidality
aspect because that is the most marked difference and all it
might be is an intensity of shame, because usually the people
that are like that have just been picked up for child internet
pornography or child sexual abuse or something about which
they‘re intensely, you know, they‘re devastated and they know
Shame: the ingenious quilt
65
that they‘ve let their families down, etcetera, and they‘ve
always had this background intention that, ―If this ever comes
to light I‘ll top myself‖. Then of course it comes to light so of
course that‘s where they immediately go. ―I‘ll kill myself‖.
Because they don‘t actually know of any other avenue of hope.
That‘s when they usually get referred to me by whatever crisis
line or police or whatever. And, um, that‘s when they get this
glimmering of hope that there could be a different way forward
that isn‘t totally destructive. Whereas women aren‘t usually in
that kind of situation; they‘re more feeling persecuted and um,
unable to function by some kind of external relationship of
sorts. And I‘m not saying men don‘t become like that as well,
but to me, it‘s the other kind is more obvious, um, the more
intense. I do get people who are chronically depressed, men,
and they‘re more similar to like women adult survivors. They
don‘t actually know what‘s wrong with them but they‘ve been
like this for a long time and it doesn‘t take long to find out that
it‘s to do with some kind of childhood issue. [SI 2]
For another participant, shame where gender was concerned was something that
women living with domestic violence (DV) or childhood sexual abuse (CSA) were
likely to feel. Shame theory affirms the powerful links between abuse and shame
(Lisak, 1994; MacKinnon, 2008). The participant did, however, recall two cases
where men exhibited such a low level of self-worth that shame suggested itself as a
likely issue:
Shame: the ingenious quilt
66
He said, ―I nearly didn‘t get here today‖. I said, ―How come.‖ I expected him
to say the car broke down. He said, ―Oh,‖ he was not working at the time. He
said, ―Oh, I started to think, oh, you never finish anything, you‘re just a waste
of time, what‘s the point of starting, um, and um, you know, you start things
and you never finish them. Kids reckon you‘re a waste of space‖. I said, again
it‘s the same thing with that woman. I said ―How come you managed to get
here, you got all these thoughts telling you not to?‖ He said, well I knew I
wanted to come. So I told my partner what I was thinking and she said, ―No,
no, I‘ve got faith in you, you go and do it ...‖ you know, because she knew of
the goodness in him… [SI 3]
One viewpoint initially surprised the researcher:
Um, (pause), well I think shame is very primary for men other—because er,
women are more relational. [SI 4]
However, Osherson and Krugman (1990) observed, citing Helen Block Lewis‘s
important text, Shame and guilt in neurosis: ―While it has been argued that women
are shame prone (Lewis, 1971), we have come to believe that men are more shame
vulnerable‖ (p. 327). If, as this participant suggested, women are more relational than
men, then it is possible that women have a greater capacity than men for re-bridging
the damaged or destroyed attachment divide. On the other hand, if men are less
relational than women, men will possibly remain isolated or alienated or at risk where
shame is at issue.
Shame: the ingenious quilt
67
Participant 4 continued:
So we know that the brain is different between men and women. We know that
women on the whole, and gay men, have a high—more equal left and right
brains so—and also the corpus callosum; they talk to each other. [SI 4]
And
So they [women] have more resourcing as to how to survive. [SI 4]
This is reflected in the likelihood of women and men seeking therapy:
Oh, men are different to women, yeah, definitely. Er, and I think it‘s
interesting because the statistics around counselling is woman will more
easily go to doctors, they‘ll ask for help, they‘ll reach out, so they tend to be
the ones who use counselling services but you will find that certain
counsellors have as many men as women and I would say at the moment
probably I‘ve got about maybe one third men, two thirds woman. Brien7
here, would have perhaps fifty per cent, maybe more men, um, and at times
I‘ve had fifty per cent so it varies a bit, but many counsellors get about ten
per cent men, 80 per cent woman so the notions about shame are actually
drawn from working with women. [SI 4]
7 Name changed to preserve anonymity and reduce identifiability.
Shame: the ingenious quilt
68
This suggests that a profitable area for further research might be in this area of gender
differences and how those differences impact on, not only the seeking of treatment,
but also shame-proneness versus shame-vulnerability, and whether or to what extent
differences exist in the manifestation of shame issues.
Differences certainly exist where shame and guilt are concerned, and the literature
revealed some considerable debate about the whether and what and how of the
distinctions (B. Brown, 2008; Sabini & Silver, 2005; Tangney & Dearing, 2004;
Tangney, Miller, Flicker, & Barlow, 1996). Three of the participants mentioned guilt
directly or described guilt using different terminology, usually in the context of
comparison with and differentiation from shame.
So whereas a person might be operating perfectly normally in the world with a
burden of guilt, what you will see with someone who is carrying a huge
burden of shame…um, this person will very often just display a physical
symptom that shows that they are struggling with being seen physically and
experiencing a shame around that, that physical, er, their physical being as it
exists in the eyes of somebody else. [SI 1]
For one participant the distinctions between shame and guilt held some theoretical
interest but were not significant in practical terms:
Labelling you as a this or a that. That‘s shame-based, but attacking you for not
picking up your clothes and for not, um, eating properly they distinguish as
Shame: the ingenious quilt
69
guilt-based. But I‘ve never—in practice you don‘t bother with differentiating.
You work with what the experience actually is. [SI 4]
And
So these are more theoretical differentiations. Some of them are helpful and
some actually don‘t make any difference...to being with people. Yeah. So
guilt, um, I guess I see guilt as to do with a highly over-active self-critic. Um,
which would have been internalised by, um, people who matter to you
growing up. But um, I also see the self-critic, I understand the self-critic in my
mind is to do with um, an absence often of a warm nurturing wise wisdom
around you. So instead of that—when that‘s missing a child will replace it
with um, with the self-critic to try and take care of you. So, I see the self-critic
is there about danger, it‘s there to protect you from being harmed or from
being rejected. [SI 4]
However, one participant did speak about guilt in terms of shame, although they did
not, as so many, from researchers to the illusive ―man [sic] on the street‖, do, conflate
shame and guilt as synonymous:
And the other one I call Ethical Shame is that—which is maybe what the man
is feeling, the ethical shame being ―My goodness, how could I have done that
to someone I cared about,‖ so it‘s a breach of ethics. [SI 3]
Shame: the ingenious quilt
70
This is the language of guilt, the ethically- and morally-definable transgression
against a known social law, I did something wrong, as opposed to the internalised,
excruciating conviction of shame that I AM something wrong (Bradshaw, 1987;
Nicolosi, 2009; Tangney & Dearing, 2004).
These, then, were some of the theoretical issues evident in the researcher‘s analysis of
the interview transcripts. The question remained, however: what did shame look like
when it walked in off the street? what, in therapeutic terminology, were some of the
―presenting issues‖?
4.2.3 Presenting issues
She said I don’t know if I’ve ever been good enough
I’m a little bit rusty, and I think my head is caving in
And I don’t know if I’ve ever been really loved
By a hand that’s touched me, well I feel like something’s gonna give
And I’m a little bit angry, well
Rob Thomas
Push
It seems that a time will come when the shame a person feels becomes overtly
intrusive. Although other signs may exist, even be apparent to the person and possibly
more so to the therapist, it is often a malaise described in general terms that leads to
therapy and treatment:
Their experiences—their subject of experience is that they feel awful, that
their—they feel terrible, but what they don‘t necessarily have is an
understanding that this was inflicted upon them. Um, from the outside. They
tend to assume that, ‗I feel awful and I am awful.‘ ... [SI 1]
The general statement of awfulness leads to further exploration of underlying issues:
Shame: the ingenious quilt
71
... and ―people hate me and people despise me because of my awfulness,‖ so
they don‘t have any place to stand, to look at what happened. And that‘s why
my way of working is to re-trace the history and to use the past and to
investigate. To start to reveal that picture, that dynamic picture of when did
you first learn to feel so bad about yourself. You see, and to ask that question
is not just about dragging up the past it‘s about trying to build in a new
perspective to see something for the first time, you know, to—and what we
think of as the therapeutic effect of that is for the client to be able to articulate
for the first time a story about how they came to be shamed. How they came to
feel ashamed and, you know, the context in which this happened to them.
That‘s a much bigger story than, ―I feel awful. I feel bad about myself.‖ That‘s
a very intimate story that doesn‘t have much movement in it. So, a more
critical story is ―How did this come to happen to me? How? And how could it
have been any different?‖ That‘s the important element to that too. [SI 1]
One of the important observable issues in presentation of pathology is repetition:
Yes. Nearly always I find that whatever has happened to a person in their
childhood of a nature that might be described as, you know, harmful,
dysfunctional or traumatising, no matter what kind of trauma it is, that will
nearly always be repeated or tend to repeat itself in the older life of the client.
Um, so that‘s nearly always my—I would say that‘s almost a universal
observation that the tendency for things to repeat are generationally. It
certainly applies to shame as much as it does to anything else. I‘m just trying
to think of an example. Perhaps an obvious example is bullying. The bullied
Shame: the ingenious quilt
72
person becomes the bully. There‘s a lot of shaming involved in bullying. It‘s
very physical. Bullying is a very physical thing, it usually focuses on physical
attributes and so a person who has been bullied and shamed in that way will
very often tend to repeat that with people who are close to them in their own
families once they grow up and have their own families. [SI 1]
Repetition of shame and shaming behaviour patterns was also something that
appeared in the context of childhood sexual abuse (CSA):
And, um, there is a shame attached to being an offender because I think, to be
called a paedophile is kind of the new leprosy. It‘s the worst name in the worst
position that a person can have put onto themselves. So there‘s a lot of shame
about that and the fact that they have committed offences that can put them in
that category. Um, but the healing process, which then gets them to take
responsibility for their offending and to be less at risk actually deals—has to
deal with the childhood shame. If that‘s not able to be, er, um, eradicated isn‘t
the right word, ameliorated or lessoned such that they can actually come back
into harmony with themselves, like, maybe forgive themselves or accept that
part of themselves that‘s done something terribly wrong. Unless they can do
that, they actually remain at risk of reoffending. [SI 2]
In this highly-specific area of CSA presenting issues were also fairly predictable:
Most people that come to see me are suicidal. They want to die. Escape from a
terrible situation they‘ve found themselves in. That‘s—that‘s most of the men.
Shame: the ingenious quilt
73
Um, most of the women are, er, disempowered in their lives. I‘m not saying
the men aren‘t but the men are more actively suicidal as a rule and then, then
their disempowerment can be worked on once they decide to live. Um, but the
women are more kind of trapped in their shame and victimhood. Um, blaming
themselves for the situation in which they‘ve found themselves. [SI 2]
This participant continued with the following crucial insights:
That‘s right. Self blame is a key concept. And of course they can‘t do anything
else if it‘s childhood stuff because the ego-centricity of childhood means that
if anything goes wrong, um, they don‘t have a concept of outside agency. They
can‘t actually attribute the blame to the adult or the outside world, um, because
they don‘t have an experience of that. That‘s why I often say to people, ―You
can‘t actually recognise you‘ve been subject—a victim of child sexual abuse,
until you‘re an adult.‖ You can know that you experienced things that you
didn‘t like or that confused you or whatever, but you can‘t actually know what
child sexual abuse is until you are an adult and realise that the things that you
experienced weren‘t appropriate. So, consequently—and of course when we‘re
born we assume we‘re the centre of everything, you know, and everything
comes from us, like we cry and our mother‘s milk appears, etcetera, then we
get older and realise that there‘s other people out there producing these things
but those very important agents say to us, ―If you‘re good, good things will
happen. If you‘re bad, bad things will happen‖. So if something bad happens
the child‘s automatic assumption is ―I must have done something bad or I must
be bad‖. [SI 2]
Shame: the ingenious quilt
74
Recognising the issue, however, was the first step towards healing:
Participant: ... yeah, ‗cause it‘s not conscious, it‘s an unconscious
experiencing you know, and attributing self-blame to it. It‘s not
a conscious attribution so until it, one can become aware and
conscious then it‘s very difficult to address ...
Interviewer: Yes.
Participant: ... in fact, that‘s why offending actually is one process by which
it can come to awareness. Like, it‘s often a way of telling a
person this is what happened to you. So, for example, with
women, often in adult life they get flashbacks to their childhood
and that‘s the sign that they can then work through it ‗cause it‘s
actually remerged. Um, with men, sometimes offending is the
first indication that anybody gets that there was something like
that in their life, because the men that are most at risk of
offending are the ones that don‘t know they‘ve been abused.
[SI 2]
As the first participant indicated, clients rarely use the word shame when talking
about their issues. In the arena of domestic violence (DV) guilt was more likely to be
an issue for men than shame, though for battered or otherwise-abused women the
experience of being abused was unquestionably shaming.
Shame: the ingenious quilt
75
Participant: So and in another case I think of when you say the word, where
a young woman who, on a scale of severity of sexual abuse you
would say nothing, but the meaning she attached to it was, it
was a Catholic family, um, bad things don‘t happen in Catholic
families, as a teenage girl her father, which she had never done
before, you know, girl sitting on her dad‘s knee that sort of
thing, touched her breasts, once and she was ―Oh‖ and then it
happened twice and she never went near him since then and the
other thing he used to do, as I remember, this was many years
ago, er, would come into her bedroom unannounced, where you
know, primary aged kids their bedroom doors are open. Once
they get to teenagers they tend to shut their doors.
Interviewer: Yes, yes.
Participant: So, and what her conclusion from that was, er, this is a good
family, bad things don‘t happen in this family. It‘s happened to
me therefore I must be a bad person.
Interviewer: I must be a bad person, yeah.
Participant: That was the conclusion she came to which isn‘t called shame
and thereafter for many years she thought, well whatever she
got however she got treated by men, sort of what she came in
about, was just what she deserved, she was a bad person. [SI 3]
The researcher received another surprise when one participant responded to a question
asking about the presentation of shame by saying:
Shame: the ingenious quilt
76
Er, well I don‘t see shame presented. Shame hides itself, it‘s of its nature, it‘s
about hiding and disappearing… [SI 4]
However, the participant continued quickly:
so it might present in many ways really. But I guess I begin to wonder about if
that‘s what‘s operating when people um, block, when they can‘t speak
anymore, when they um, they get overwhelmed with affect or feeling. Er,
when they can‘t look at you. Er ... When they put their hand to their forehead
and hide their eyes like this. So, when there‘s any kind of hiding. Um, when
there‘s any kind of switching going on; disassociation happening. I would
associate shame with disassociation. [SI 4]
The researcher was unsure whether the participant had initially misunderstood the
question. Nevertheless, the researcher realises that the question itself may have lacked
clarity. The participant‘s response precisely reflected shame theory: ―shame hides
itself‖; so logically no one would ―see‖ it in an obvious way. The participant,
however, indicated clearly that they were attuned to the signs of shame‘s (hidden)
presence:
I think one just intuitively works with what‘s there but I think the thing about
shame is one finds oneself slowing right down, pulling out from trying to ask
questions, stopping going with the content and slowing, pulling right back to
not force, not push, not put anything in… [SI 4]
Shame: the ingenious quilt
77
Of considerable importance was the theme that this participant‘s now introduced: the
treatment and, possibly, healing of shame.
4.2.4 Therapy
Primum non nocere8.
Attributed to Hippocrates;
probably coined by Dr Thomas Sydenham
The overtly-articulated therapies the participants used in their practices included
psychodynamics, narrative therapy (the Dulwich Centre modality), and an eclectic
approach that incorporated skill-sets and techniques from several other recognised
modalities (for instance, CBT, Behaviourism, narrative story formation, depth
psychology). In all cases, however, the researcher found that the guiding principles of
praxis were closely-enough related to Person-Centred Therapy (PCT) as to be, in
practical terms, indistinguishable from it.
One participant was clear beyond question that no shame-based client should
experience shame in therapy:
Because this person has already suffered an invasion, an invasive injury, and
so the first thing that would be on my mind is to establish trust and safety and
to really make clear the separation between the two people in the room. In
other words, um, if we think of shame as an attacking and invading kind of
experience, um, it would be very important for someone suffering from a
burden of shame or having a core of shame that they‘re not going to re-
experience that in therapy; that a person is not going to be delving in and so
8 First (or, Above all), do no harm.
Shame: the ingenious quilt
78
that‘s the first thing to establish; trust and safety and separateness. The other
important element of the separateness I think is that in many ways what the
shamed person needs in therapy is a new experience. They need a new
experience of somebody looking at them and yet so, so, what I‘m going to be
for that shamed person is I‘m going to be another person on the outside, I have
my own set of eyes, I‘m looking at the person and they would be expecting a
shaming type of experience. That‘s been their experience but when a person,
especially someone who they might imagine is an authority figure or a father-
figure or something, so this is where transference is an important element here,
they might be expecting another shaming experience. They might lapse
automatically back into that subject of anticipation of being shamed. [SI 1]
This participant expressed a beautiful and sensitive attitude of care:
they [the client] might just want to tell you that they feel helpless or hopeless,
um, they might just want to tell you how bad it is and they might not be
particularly hopeful at that point. They might just have nowhere else to go and
what they want to do is they want to borrow from your hopefulness. So in that
situation as a therapist, it is your job to be hopeful. They might be all out of
hope. They might actually be in a stage of despair and therefore the person
who is hopeful is the therapist. And you wouldn‘t necessarily say I‘m hopeful
for you, even though you are not. You might say that but basically you‘ve just
got to be hopeful and you‘ve got to convey that just through your manner and
your constancy and your reliability. [SI 1]
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79
Each participant in different ways expressed this same respectful attitude of hope and
―doing no harm‖. Hope was an important consideration for another participant:
Like I think—I guess I use the suicidality aspect because that is the most
marked difference and all it might be is an intensity of shame, because usually
the people that are like that have just been picked up for child internet
pornography or child sexual abuse or something about which they‘re
intensely, you know, they‘re devastated and they know that they‘ve let their
families down, etcetera, and they‘ve always had this background intention
that, ―If this ever comes to light I‘ll top myself‖. Then of course it comes to
light so of course that‘s where they immediately go. ―I‘ll kill myself‖. Because
they don‘t actually know of any other avenue of hope. That‘s when they
usually get referred to me by whatever crisis line or police or whatever. And,
um, that‘s when they get this glimmering of hope that there could be a
different way forward that isn‘t totally destructive. [SI 2]
This participant expressed the theme slightly differently at the end of the interview:
I really am a fan of Erickson and his approach because what he says is if we
don‘t succeed in that life-task between 18 months and 3 years of age, then we
hit another failure experience in our lives later on, we come back and we‘ve
got another opportunity to actually, um, deal with that. That‘s what I love
about it. It‘s not—it‘s a never ending life work {{where ? 54:37}} we‘ve
actually fallen into the pit of shame, um, and we pick ourselves up and carry
on, and we fall again, that‘s not, that‘s not a failure, it‘s another opportunity to
Shame: the ingenious quilt
80
actually do it differently which is how I regard offending. Is that if a person‘s
been a victim and then they offend then the offending is the first sign of—well,
not the first sign but it‘s a very clear sign that that earlier stuff has to be
addressed and so it gives you that opportunity to address it where if you were
blight—if you managed to escape offending just by accident, not getting into a
situation where it popped up, you would still have an unresolved dilemma that
you were unhealed of. [SI 2]
This participant had used a variety of techniques over the years in approaching both
individual and group therapy, although they had now become ―integrated‖:
I used to [use a variety of approaches] but they‘re all integrated now into my
approach. (laughing). But, um, er, the most common would be to help, er,
people just follow their feelings, their physical sensations in their body and
their feelings and also be to get them to recall um, childhood memories in a
kind of narrative fashion. So experiential, narrative, um, occasionally I use um,
cognitive behavioural techniques or rational and emotive therapy ways. Like if
a person is in a state about something in the present then I will work in the
present as well and not always go back um, to kind of um, unveil their
negative self talk or say, for example, in talking with somebody about feeling
shame in the present, I might go back and ask them to think about what‘s
triggered it. What is the activating event and what‘s their way of talking about
it. And, some of the ways that trigger the shame are, ―I should‘ve known
better,‖ or ―There‘s something wrong with me that I didn‘t do this,‖ or ―This
person has found me out‖. You know, so all sorts of self talk ... [SI 2]
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81
By contrast, one participant was committed to Narrative Therapy:
my interest is narrative therapy, that‘s my, my passion if you like [SI 3]
One of the primary techniques involves asking questions to elicit counter-stories and
affirm ―unique outcomes‖:
... so all this bringing out the things she did is the beginning of that story,
wasn‘t okay with me, I didn‘t do anything to...‖ you know, and things of, I‘ve
said to her, ―I wonder. How come there are two women in your house. One
was an adult, one was an eight year old girl. Why do you think the man who
abused you picked on you and not your mother?‖ She just laughed, ―Well, my
mother would‘ve slapped him in the face‖. ―So do you think he deliberately
chose an eight year old girl?‖ Even that has meaning, you see, like the
grooming idea rather than her being flirtatious. So once you ask questions that
start to change—without telling her this, she comes to this conclusion herself.
Once they start to answer questions it changes the meaning of things, then they
can start to change one wonderful occasion for me, and for her, once she
became a little freer of the self-hate and the worthlessness, er, she used to say,
―But I feel dirty,‖ and she was referring to her genitalia. ―I just feel dirty‖. I
said to her, ―I wonder if you think that it would be more appropriate if the
people who did the dirtying, the people who did those things to you, I wonder
if they should be feeling the dirtiness and not you, the one who it was done
to?‖ And she came in the next week. She said, ―I don‘t feel dirty anymore‖.
Again a question that changed—I didn‘t tell her this; I asked her the question.
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Somehow you‘re left to carry the burden of what was done to you against your
wishes. And they got off scot-free. Then she started to talk about anger. She
said, ―I think I‘m turning into an angry woman‖. And then we had a
conversation where she turned it into indignation and outrage, ―How dare they
do this to me‖. So, um, this particular person talks about, er, life-changing
questions and that one around the dirtiness was one that just was so profound
in its ability to—for her to re-interpret—for her to re-interpret the meaning of
things. She could‘ve said, ―No. No, I‘m just...‖, but she didn‘t. She sort of was
able to put it out there; ―They‘re the ones who should be feeling dirty because
they did it to me‖. And somehow for her that freed her. [SI 3]
Again, the participant shows considerable care and respect for the client. This is not to
suggest that any of the participants were unable or unwilling to confront or challenge
clients when necessary. Narrative Therapy itself challenges lifeworlds that clients
have come to regard as ―normalised‖ (for them) even though these lifeworlds may
inherently be painful and pathological. One participant spoke about guiding clients‘
thinking using perhaps more traditional techniques:
You know, so, challenging irrational beliefs is another one I use. Teaching
people how to be assertive rather than aggressive ... [SI 2]
For another participant their own assertive style with resistant clients involved
meet[ing] them where they‘re at. So they will benefit from concrete plans,
concrete advice and a more of a re-parenting in the sense of being a wise, sane
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mind that they can borrow. And I think some of the domestic violence
counsellors do wonderful work over years, it takes years and years, to have
any hope of an impact. But, really I think, um, those who cannot hang in to a
counselling relationship – counselling is not for the whole population. [SI 4]
This acknowledgement that ―counselling is not for the whole population‖ found an
echo in comments another participant made:
I think—I think—it‘s a philosophical decision that every human being is
treatable. It doesn‘t mean every human being will be able to be treated for
what their problem is. [SI 2]
because
we‘re not clever enough or because we don‘t actually have the right kind of
understandings of what‘s a good way of treating, we choose, it doesn‘t happen,
you know. But I do have a philosophical and practical position that says there
is hope of change and we have to address that and make it available if we want
to improve society or protect children, um, and if we don‘t we‘re responsible
for the fact that there‘s not been a change. [SI 2]
Nevertheless, for those seeking help who are struggling with shame, one participant
was clear about what counselling needed to provide:
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84
I think one just intuitively works with what‘s there but I think the thing about
shame is one finds oneself slowing right down, pulling out from trying to ask
questions, stopping going with the content and slowing, pulling right back to
not force, not push, not put anything in. So, I find myself working very gently,
not um, wanting to go anywhere. So, I‘m…I‘m tuning, attuning more to what
the person can tolerate and what‘s okay and what‘s not okay. So I find myself
asking for a lot more permission. ―Is it okay if I ask this?‖ Or ―Is it okay if we
do that?‖ ―Would it be okay to just sit quietly for a while?‖ So, a lot more of
that approach with shame. [SI 4]
This participant‘s view on healing shame was almost Zen-like:
I don‘t think there is any way of fixing shame itself or—and I would—I don‘t
even have in my mind a goal to remove it. My goal is more to respect it rather
than to move it or change it. [SI 4]
and:
It‘s like to come alongside this horrific awful, experience. Quite apart from the
thing that caused it, is the experience of shame is an overwhelming experience.
[SI 4]
and:
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85
I think—I don‘t—my goal is not to get rid of shame. It‘s actually, um, it‘s
really to approach what has given rise to that with compassion and gentleness
and understanding and that frequently dissolves the experience the person can
move beyond the shame but the vulnerability to shame remains. It‘s very hard-
wired, especially if it‘s happened under five years old in the shaping of the
personality. [SI 4]
And in the end, in its way echoing the words of the first participant‘s example, this
participant ended with this poignant statement of belief:
I think the value of psychotherapy and counselling is that you have the
assistance of another who is warm and um, on your side, um, to wonder and
explore some of the events and ways one thinks about and feels about the
events on one‘s life. Um, that process develops a capacity for wondering,
observing with kindness. [SI 4]
And that
…internalises that capacity and that‘s, I think, the purpose of therapy, to
develop that. So you borrow your therapist‘s interest, unfailing presence and
warmth and curiosity to assist you to differentiate some of the snowball that‘s
inside into at least smaller snowballs and then see that this one‘s different to
that one. So, further and further differentiation. We can only get that with
observing self. Some people can‘t do that and it‘s not going to be possible in
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their lifetime to develop that so there are some people who do not have a
reflective space. [SI 4]
Because they
have never had a relationship where they‘ve been held in the mind of another.
[SI 4]
4.3 Conclusion
The participants who agreed to be interviewed for this study came from different
backgrounds, with different theoretical perspectives underpinning their praxis. One
was relatively ―young‖ in practice, another had practised for four decades. All spoke
with considerable authority about their professional practice and about the issue of
shame as they experienced it as psychotherapists. What was apparent was that they
were all committed to helping their clients using the tools and techniques with which
they, as practitioners, worked most effectively, and although modality played some
part in their thinking, and counselling and psychotherapeutic ethic, each was less
concerned with theoretical positions than with helping clients in need. This is not to
suggest that any were disdainful of theoretical principles: their individual and
combined knowledge clearly indicated that the participants were conversant with
shame issues. However, praxis was the dominant concern, and each participant was
able to demonstrate an informed and respectful professional approach.
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PART 5: DISCUSSION
Translators and theologians like to use the word difficult when describing passages of
scripture that are particularly demanding, either because they contain linguistic ambiguities,
or because the content of the text might offend comfortable beliefs or longstanding doctrine.
The researcher was happily surprised that the participants in this study on the relationship
between the affect shame and the presenting issues of those who came seeking therapy were
not only conversant with shame theory but willing and able to articulate their views and
discuss their practices.
Because shame is undeniably a very difficult affect, an emotion about which people would
prefer to remain silent (B. Brown, 2005; 2008).
However, the study has revealed that it is possible to talk intelligently and with authority
about a subject whose nature is such that the danger is ever-present that issues of transference
and countertransference can create at best uncomfortable feelings in the therapy room. To
some extent shame has the notorious reputation for osmotically dragging to the surface the
therapist‘s own shame-horror. This is one of the reasons that few people, according to Brown
(2008), wish to talk about shame.
Most of the data collected and analysed was not, ultimately, surprising. The major issues
shame theory advances were present – abuse in all its grotesque shapes and polychromatic
muddiness, familial dysfunction, the propensity for the human being to smell blood and
savage and devour with scant mercy. Perhaps the researcher was too optimistic in thinking
that lesser-known issues might rise to be discussed. Eating disorders and addiction did not
enter the arena; anger was present, but hid beyond the boundary ropes; so too bullying.
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Likewise the wider issue of family systems, despite the appearance of dysfunction, which
nevertheless alighted on the usual suspects (Bradshaw, 1987; Engel, 2006).
Was the study worth doing? Unquestionably!
The researcher continues to believe that shame is an area that remains under-studied and that
the psychological community in the widest sense of the term will benefit from further
research and insight. Shame research seems to have proceeded in something of a sine-wave
fashion, with a slow Freudian beginning, little attention for decades, then an upward wave of
interest in the 1970s and 1980s. Names such as Helen Block Lewis, Donald Nathanson, and
Gershen Kaufman come to mind. Then another trough, short-lived thanks to the vigorous and
prolific emergence of June Price Tangney (and associates). More recently the twilit world
between academic and self-help has seen the appearance of Brené Brown, who is media-
literate, knows how to ―do‖ qualitative research, and is easily found on YouTube.
Nevertheless, several areas of potential further research and study persist. Emerging from the
results of this study, the following suggestions seem pertinent:
Shame and the imagination. How do shame and the imagination relate to one
another? What is the defining role of the imagination in creating shame-based
persons and scenarios?
Neurological perspectives. Certainly some study has occurred in this area.
Cozolino, Siegel and Badenoch come to mind. More would be welcome,
especially as knowledge of the neurological has the potential to be of great
clinical assistance.
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Gender issues. Perhaps a somewhat hoary suggestion. However, it remains
unclear and ambiguous what differences exist between the female and male
reception of shame. How do notional differences affect treatment options, if at
all? What developmental issues should therapists be aware of?
It may be that ultimately that the best treatment for shame is also a wider community
education programme. Let shame be the subject of discussion. Let those who, like this
researcher, are shame-based speak openly about the affect and its effect. Dispel the persistent
ignorance that conflates shame and guilt, and proffer wiser and sounder solutions to the
maddening drum-beat demanding the imposition of shame on fellow human creatures.
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PART 6: CONCLUSION
The study of shame gives the researcher a feeling somewhat akin to the affectional equivalent
of the opening salvo of A tale of two cities: much is known about shame; little seems to be
understood about shame. At least one theorist, attentive to other concerns, has advanced the
notion that shame underpins all or most psychic pathologies (Resnick, 1997), and Holloway
(2005) quotes Tangney‘s observation that ―shame is associated with virtually every DSM
disorder‖ (p. 22). Resnick‘s view is a little jaundiced: the therapeutic tool is a hammer, and
every pathology looks like a nail. He is suggesting it is necessary to be more discerning about
the therapeutic uncovering of shame, that perhaps other pathologies warrant attention.
It is an issue worth attending to. But it does not mean that shame should cease to be the focus
of intelligent research and discussion. Discernment is a wise road down which to travel, but
the participants in this study demonstrated that wisdom.
The researcher concludes that judgement continues to be necessary in the field, and that
practitioners will continue to be attentive to their clients on a case-by-case basis. None of the
participants in this study conveyed the impression that they would simply launch into a
therapy without first gathering every piece of relevant and available evidence from their
clients.
Whatever DSM may say and whatever may be Dr Resnick‘s fears, the researcher remains
confident of at least two outcomes: shame is worth the effort of continuing and expanding
study; practitioners will and do attend to their clients, not by elevating theory beyond
practice, but by discerning, caring, and, to use the poignant and elegant phrase of participant
no. 4, holding each client in their mind.
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APPENDIX A
CONSENT FORM
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SHAME IN THERAPEUTIC PRESENTATION
I N F O R M E D C O N S E N T FO R M I, (participant’s name) _________________________________hereby agree to being a participant in the above research project.
I have read and understood the Information Sheet about this project and any questions have been answered to my satisfaction.
I understand that I may withdraw from participating in the project at any time without prejudice.
I understand that all information gathered by the researcher will be treated as strictly confidential, except in instances of legal requirements such as court subpoenas, freedom of information requests, or mandated reporting by some professionals.
Whilst the research involves small sample sizes I understand that a code will be ascribed to all participants to ensure that the risk of identification is minimised.
I understand that the protocol adopted by the University Of Notre Dame Australia Human Research Ethics Committee for the protection of privacy will be adhered to and relevant sections of the Privacy Act are available at http://www.nhmrc.gov.au/
I agree that any research data gathered for the study may be published provided my name or other identifying information is not disclosed.
PARTICIPANT’S
SIGNATURE:
DATE:
RESEARCHER’S FULL
NAME:
RESEARCHER’S
SIGNATURE:
DATE: 2011
If participants have any complaint regarding the manner in which a research project is conducted, it should be directed to the Executive Officer of the Human Research Ethics Committee, Research Office, The University of Notre Dame Australia, PO Box 1225 Fremantle WA 6959, phone (08) 9433 0943.
APPENDIX B
INFORMATION SHEET
103
Dear potential participant, My name is .................... I am a student at The University of Notre Dame Australia and am enrolled in a Master of Counselling degree. As part of my course I need to complete a research project.
The title of the project is……………………………………………. My research concerns………………………... ……………………………………………………………………………………………………………………………… The purpose of the study is to ………………………………………………………………………………………….. Participants will take part in a 50-60 minute tape-recorded interview. Information collected during the interview will be strictly confidential. This confidence will only be broken in the instance of legal requirements such as court subpoenas, freedom of information requests or mandated reporting by some professionals. To protect the anonymity of participants in a project with a small sample size, a code will be ascribed to each of the participants to minimise the risk of identification. The protocol adopted by the University of Notre Dame Australia Human Research Ethics Committee for the protection of privacy will be adhered to and relevant sections of the Privacy Act are available at hppt:/www/nhmrc.gov.au/ You will be offered a transcript of the interview, and I would be grateful if you would comment on whether you believe we have captured your experience. Before the interview I will ask you to sign a consent form. You may withdraw from the project at any time. Data collected will be stored securely in the University’s School of Arts & Sciences for five years. No identifying information will be used and the results from the study will be made freely available to all participants. Due to the sensitive nature of this issue, the interview may raise some difficult feelings for you. If this happens I will make sure that support is available for you if you desire it. You will be provided with relevant counselling information at the interview and contacted by the researcher one week afterwards. The Human Research Ethics Committee of the University of Notre Dame Australia has approved the study. Professor Martin Philpott of the School of Arts & Sciences is supervising the project. If you have any queries regarding the research, please contact me directly or Professor Philpott by phone (08) 99433 0218, or by email at [email protected] I thank you for your consideration and hope you will agree to participate in this research project.
Yours sincerely,
..............................
Tel: (08) ................ Email: [email protected]
If participants have any complaint regarding the manner in which a research project is conducted, it may be
given to the researcher or, alternatively, to the Provost, The University of Notre Dame Australia, PO Box
1225 Fremantle WA 6959, phone (08) 9433 0941.
APPENDIX C
104
THE DATA COLLECTION INSTRUMENT
Interview schedule
• What do you understand by “shame”? How common is it for clients to present
with shame?
• In your view, what is the difference between healthy shame and toxic shame?
• To what extent do your clients recognise shame as a therapeutic issue for them?
How is shame manifested by clients?
• If you are treating a client’s shame as a significant therapeutic issue, what
strategies or therapies do you use?
• How would your therapy approach differ if shame is a peripheral issue for clients?
How would your approach differ from working with clients who are not shame-
based?
• In your experience, what are some of the ways clients try to mask or hide their
shame?
• What is it, in your view, that helps resolve issues of shame?
Shame: the ingenious quilt
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LIST OF TABLES
Table 1: Participants
Table 2: Themes and sub-themes