Patti Ashley – Toxic Shame in Clinical Practice: Help Clients Release Shame, Get Unstuck and Improve Treatment Outcomes

Outline

PART ONE: HOW SHAME SHOWS UP IN TREATMENT
Toxic Shame
Research & Definitions

• Ruptures in interpersonal relationships create a shame-based identity
• Shame and trauma function similarly in the nervous system
• Subconscious shame effects of poisonous parenting
• Attachment theories as they relate to shame
• D.W. Winnicott’s true self/false self
• Shame in family, culture and other systems
• Limitations of the research

Signs of Toxic Shame:
What to Watch for in Assessment and Beyond

• Individual Therapy – the client who:
  • Talks the whole session
  • Frequently cancels sessions
  • Feels bad when progress seems to have eluded
  • Terminates treatment early
  • Deflects and projects onto others
  • Relapses and does not return
  • Minimizes problems
  • Excessively intellectualizes and analyzes treatment
• Couples/Family Therapy
  • The attack/defend patter
  • Anger, rage and contempt
  • Judgment of self and others
  • Grandiosity, narcissism and self-inflation
  • People pleasing and codependency
  • Avoidance
  • Problems with intimacy
• Group Therapy:
  • Cross-talk
  • Intellectualizing
  • Silence
  • Judgment
  • Conflict

When the Therapist is Part of the Problem
Rigid Treatment Models May Increase Shame and Decrease Positive Outcomes

• Shame can be activated when therapist appears to be the “expert”
• Some strategies hinder treatment outcomes
• Strategies that may create barriers to creativity and relational presence
• Impact of mirror neurons and epigenetics
• How naming “shame” can be shaming
• Unconsciously enacting shaming parent
• Treating client as appointment or diagnosis
• What to do when your shame is triggered in-session

PART TWO: TREATING THE TOXIC SHAME
Effectively Treat Toxic Shame
Implications for Treatment to Move Forward with Clients

• Right and left brain integration
• Bottom-up versus top-down treatment approaches
• Modeling, engaging and sustaining self-compassion
• Repair the interpersonal bridge to self and others
• Courage and vulnerability in right-brain regulation
• Sustaining empathy in parallel process
• Transference and counter-transference in treatment

Therapeutic Strategies:
Putting It All to Practice

• Build a Safe Therapeutic Holding Environment
  • Establish safety and trust
  • Set a stage for treatment
  • Strong foundation for therapeutic work
• Build a Solid Relationship
  • Therapeutic empathy as the antidote for shame
  • Connect and establish equal power
  • Mindfulness and compassion
• Bridge the Head and Heart
  • Psycho-education to demystify shame
  • ”I” statements to identify shame-based feelings
  • Going beyond cognitive therapy models
• Witness and guide clients through deeper layers
  • Return shame to its origin
  • Somatic strategies
  • Re-wiring new neural pathways
• Experiential Tools and Techniques
  • Creative arts, writing and movement activities
  • Mindfulness and meditation
  • Archetypes, story-telling and mythology
  • Music and sound healing
  • Journaling and letter-writing
• Working with Secrets
  • Patience and compassion
  • Deeper shame
  • Tolerance and non-judgmental witnessing
• Creativity
  • Every client is unique
  • How therapy is like art
  • Goodness of fit
• Research limitations and potential treatment risks