17 November 2022

Where is Shame Held in the Body?

Category: Depression

Shame is an emotion that is experienced by everyone but that often goes unacknowledged or intentionally hidden. In this article, we discuss the physiological presentation of shame as it exists in the body. This includes addressing areas such as: nonverbal signs of shame; where shame is held in the body; and what shame feels and looks like in the body.

When experienced acutely, shame can be a feeling that is overwhelmingly painful and might feel like an invasion or intrusion threatening one’s safety or well-being. When experienced chronically, shame can feel heavy and burdensome. Chronic shame has the potential to lead to other mental health struggles, such as isolation and rage, and might require one to seek treatment for depression or anxiety therapy.

Despite shame’s potential harm, healing and letting go of shame is possible with the help of therapy. Shame held within the body can be healed somatically, emotionally, and relationally through therapeutic processing, which we’ll discuss.

What is Shame?

Many people often confuse shame and guilt with each other. These two emotions may sometimes feel similar, and both often occur in reaction to an indiscretion or misdeed; however, they actually have very different meanings and motivations.

On the one hand, guilt signals to you, “I did a bad thing,” and you may feel motivated to rectify the situation or make up for something. Guilt often leads to action and occurs when your mind has decided that you have done something specific that is bad.

Alternatively, shame tells you, “I am bad,” and it motivates you to freeze in place, often leading to inaction. Shame, then, occurs when your mind has decided that you are globally a bad person because of something you have done, which is a much more paralyzing experience.

Shame is an emotion that is held in the body and that has been described as a dysphoric affect (unhappy emotion) along with a collapse of self-esteem, feelings of humiliation, rupture of self-continuity, a sense of isolation and being cut off from the surroundings, and feelings of being watched by critical others (Akhtar, 2016).

Another way of looking at shame is the feeling of discrepancy between the self that a person projects to the world (how a person tries to be seen by others) and the self that is concealed or hidden from others (Gonzales, 2012).

Shame is referred to by many emotion researchers as a ‘universal emotion.’ As such, it is an emotion that seems to transcend language, culture, and location. This is not to say, however, that all shame experiences are identical. While most, if not all, people have the capacity to experience shame, it is also true that shame experiences exist on a spectrum. It also does not mean that shame cannot be worked through.

Nonverbal Signs of Shame

Shame is connected to processes that occur within the limbic system, the emotion center of the brain. When something shameful happens, your brain reacts to this stimulus by sending signals to the rest of your body that lead you to feel frozen in place. This process then produces behaviors and body language that act as nonverbal signs of shame.

Darwin (1872) was among the first to connect a flushing of the face, or a rush of blood to the cheeks, with the internal experience of shame. Flushing can be an uncomfortable experience for some people, distracting them, further preventing them from purposeful action. He also attributed confusion, downcast eyes, slack posture, and lowered head as outward physiological signs of an internal shame experience.

Additionally, shame often causes a physical feeling of collapsing one’s posture, a way of retreating into oneself or making oneself smaller. Many researchers see shame as an emotion that occurs in response to a perceived or actual threat to interpersonal connection or sense of belonging; and collapsing into yourself functions to withdraw from potentially threatening interactions or to signal to others that you are not open to interaction. In other words, impulses to cringe or make yourself feel smaller are bodily responses to shame feelings that allow you to “escape the painful gaze of others” (Lewis, 1992, p. 23). While shame occurs in response to threats to belonging, it makes you want to hide yourself from others in order to avoid future threats of the same kind.

In sum, there are several prominent examples of nonverbal (observable) signs of shame. In the body, shame is held in the face (flushing), eyes (downcast), head (lowered), and posture (slack). The photo below demonstrates many of these physical cues:

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What Does Shame Look and Feel Like in the Body?

The symptoms listed above are the interpersonal physical manifestations of shame. Intrapersonally, or within your own internal experience, shame can be one of the most painful emotions you may feel. While all experiences are somewhat different, pain and discomfort to some degree are likely involved. Because shame is held in the body, the pain and discomfort can be both physical and emotional.

This may include an uncomfortable and pronounced self-consciousness, one where you feel hyper-aware of your body, self, or being. Alternatively, it may feel like an uncomfortable disconnection from your body, one in which you feel wrapped up in thoughts related to the shameful event or your being ‘bad.’ It is also possible that both of these experiences co-occur, meaning that you feel both self-conscious and disconnected from yourself at the same time.

Being a body-based emotion, shame is a uniquely self-focused experience, and this translates into it being categorized as a self-conscious emotion, which is likely to be accompanied by lowered self-esteem and increased self-attention. Because of this unique combination of internal experiences, the body reacts as if interaction with others is a threat. Therefore, the autonomic nervous system, particularly the sympathetic nervous system, gets activated, leading to the physical sensations mentioned above along with a sense of unease that may originate in the chest, abdomen, or head and radiates outward through the limbs as a way of readying your body for incoming dangers. Shame, when especially strong, may make you feel as if you want to ‘crawl out of your own skin,’ indicating the dissonance between your self and what you think the shameful event says about you.

When left unattended, shame has the potential to lead to other mental health symptoms, such as depression, anxiety, or uncontrolled anger:

Shame and Depression

Depression, for example, can manifest out of prolonged shame as a result of repeated rejection or interpersonal disconnection. This then turns into a ‘shame-depression spiral,’ one in which the depression feeds into more shame (shame about having depression), which feeds into more depression (depression about ongoing shame and disconnection). Some occasional experiences of shame are completely normal and, in fact, universal; however, it is when shame becomes chronic that it becomes worth addressing.

Shame and Anxiety

As a body-based and self-conscious emotion, shame can also often lead to an increase in anxiety. When shame leads to the impulse to withdraw from others, this often occurs due to the feeling or perception of having too much negative attention on yourself from others. Your body interprets this as a threat, therefore increasing your fight-flight-or-freeze response. When this response occurs but there is no physical threat, your mind interprets your body’s signals as anxiety.

Healing Shame

Below we describe three therapeutic strategies that can be used for healing shame:

Use Language to Label the Shame

It often takes some time to realize that you are feeling shame while it is happening. When first recognizing that shame is getting in the way of being the kind of person you want to be or is getting in the way of your internal peace, it is most important to name the shame as early in the shame process as you can. Putting words to your emotional experience allows for connection between your right brain (negative emotions) and your left brain (positive emotions and language). Naming the shame, literally telling yourself “I am feeling shame,” allows you to ground yourself in your experience, validate your emotions to yourself, and prove to yourself that you are separate from the shame.

Create an Anchor Point and Ground Your Body

In the same vein, grounding yourself in your body soothes your sympathetic nervous system in order to deactivate the fight-flight-freeze response that shame initiates. It permits you to feel safer within your own body and work through the shame to better understand it so that it does not control your subsequent actions. To ground yourself within your own body, take a moment to feel your feet planted firmly on the floor, put your hand firmly on your chest, and take a few deep breaths while paying attention to the physical sensations of your feet on the floor and your hand on your chest. Give yourself permission to belong in your own body.

Describe Your Emotional Experience with Someone You Trust

Finally, shame functions as a way of keeping us isolated, withdrawn, and disconnected. In order to really prevent shame from taking its power, consider sharing your emotional experience with a trusted person. Even just naming our experience to another person can feel so regulating. Naming takes the nonverbal experience and signs of shame and puts it into words that are easier to let go of and heal. Let someone who you consider to be safe know that you had a moment of shame, and allow yourself a moment of re-connection. A mental health professional with whom you build a working relationship can be an excellent source of validation and support in the face of shame experiences. Curiosity and therapeutic questions also help change the shame experience. Shame often makes us want to hide, but the antidote to shame is to let yourself be seen.

This article was written by Jayna Burleigh, Psy.D., who worked at Attune from 2022-2023. Article was researched, edited, and published by Eric Spiegel, Ph.D., a licensed psychologist specializing in the treatment of shame and depression.

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Eric
Spiegel Ph.D.

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Eric- Spiegel - Attune Philadelphia Therapy Group

20 September 2022

Pros and Cons of Therapy

By developing a deeper understanding of what the pros and cons of therapy might be, you can better prepare for what to expect out of the process before your session.

In general, there are many benefits of therapy, and very few disadvantages or cons of therapy, with a few notable exceptions.

Pros of Therapy: The Benefits

Let’s start with a clear statement: therapy is effective. The American Psychological Association adopted a resolution on the recognition of psychotherapy effectiveness, based on numerous research meta-analyses studying therapy. These studies found that therapy is effective across for a variety of issues across a large range of populations. (even therapists go to therapy.)

Here are 3 pros or benefits of therapy that help explain why it is effective:

1. You are talking about your issues, instead of holding them inside.

It is difficult to appreciate how much better you will feel simply by beginning a process of talking with someone about concerns you may have previously held inside. Many of my new clients will tell me after a first session what a relief it is to get out of their heads and into a meaningful dialogue with an empathic professional who is listening carefully.

2. You are speaking with a professional who is trained in understanding mental health, and providing treatment to improve it.

Let’s answer a common question – “is a therapist better than a friend?” – with a simple and resounding answer. YES. Most therapists are skilled (to varying degrees, depending on training and competency) in sophisticated aspects of emotional presence, relational attunement, and empathy. They should be good listeners, and just as importantly, use that listening to help you reach levels of understanding about yourself that you previously did not have.

Therapists are also trained in different types of therapeutic questions and interventions to help you identify and revise problematic thought patterns, understand and manage overwhelming feelings, and modify maladaptive behaviors.

Obviously, there are a range of techniques and approaches that were just outlined, and what you “do” in therapy will differ vastly, depending on the training and philosophy of the therapist who you are working with.

Although the first two reasons have benefits in and of themselves…

3. Working with a therapist with whom you have a good alliance, connection, rapport, and bond will help you!

Each of these words explain the way that you feel aligned with your therapist. Research finds that this relationship connection is established early in treatment, on an intuitive level, and that this bond has a huge impact on treatment outcomes. Relationships matter!

If you feel like your therapist ‘gets’ you, that is going to take the treatment a long way. Although your relationship with your therapist should be a professional one, with an established framework and boundaries, it is also comparable to other types of relationships in that there are varying degrees of fit. For example, we all have different degrees of close friendships and dating relationships.

Cons of Therapy

The process of therapy really can’t ‘hurt’ you, unless it’s perhaps an exceptionally poor fit with your therapist. From this perspective, I would reframe ‘risks’ of therapy, as disadvantages. So what might those disadvantages of therapy be?

Let’s start by going back to benefit #3, having a strong therapeutic alliance. The flipside would be not having a good fit with your therapist. Lets explore this.

1. Sometimes you don’t have a good fit with your therapist.

When the fit is poor, therapy can feel like a waste of time. All of this comes down to what style works well for you. Here are some examples of poor fit:

The overly passive therapist

While there are some treatment approaches that encourage therapist neutrality – and this can be beneficial – some therapists take this to an extreme and say very little in sessions. This can leave clients feeling unheard or alone.

The robotic therapist

This is a therapist who overly uses cliches like “how does that make you feel?” and doesn’t seem particularly imaginative or skilled.

The overly active therapist.

Some therapists may feel too active. There are treatment approaches that involve skills-building, homework and other task-focused activities. Some people love this type of structure in the treatment. Others chafe at the amount of action, and feel that it detracts from being more deeply heard and reaching new levels of understanding.

The overly self-disclosing therapist

There is healthy disagreement amongst therapists about what is the appropriate amount to self-disclose in treatment. In general, most therapists focus on their clients, and make limited self-disclosures related to the treatment process (e.g. what it feels like to be together, how it feels at certain key moments in a session). Sometimes when a therapist and client have been working together for a while, the therapist may – in an appropriate manner – share a bit more about their lives.

This has been more highlighted in the age of online therapy where therapists may be working from their homes. This is also true when a therapist has a home office for in-person sessions. However, with that said, there are definitely therapists out there who are either poorly trained or disregard their training (for their own unaddressed psychological needs) and make the session more notably about themselves.

While this tends to be a rarity, if you start to notice a trend where your therapist is relating everything back to themselves, that could be problematic and is worth discussing and, if not positively resolved, switching therapists.

2. Sometimes the fit is good, but as you get deeper in the treatment, you may become disappointed in your therapist’s response (or lack of response).

Let’s face it, therapists are human. Sometimes there is a difficult issue that may unwittingly push a therapist’s “buttons” based on their own life experiences. It could be anything, including timeliness, money, health, existential issues, relationship issues, etc. Therapists are trained to recognize when they are having stronger-than-usual reactions. In such situations, they are encouraged to seek professional consultation about this issue, or therapy to address underlying issues which may be getting activated.

However, it’s also important to recognize that these types of situations are also a tremendous opportunity. The late Jeremy Safran, a psychologist who specialized in ‘rupture and repair’ in the therapeutic relationship, remarked that therapy doesn’t truly begin until there is a rupture (e.g misattunement, misunderstanding, disagreement, conflict, etc.). Such moments allow therapist and client a chance to process what happened and come to a shared understanding that deepens the relationship. It also may provide clients with a chance to talk about their feelings in a way that has not been possible in other relationships. So while this is on the ‘con’ list of therapy, it also has the opportunity to become a ‘pro’ as well.

Which brings me to #3 in our list of disadvantages of therapy…

3. Shame can really be an obstacle to therapeutic growth (and intimacy in any relationship, for that matter).

If you’re someone who chronically feels like you’re not enough, and if you’re uncomfortable looking at yourself openly, you may experience the process of therapy as a threat… even if you have a good reason for doing it.

Because therapy involves a therapist who is listening closely and empathically ‘mirroring’ you, if your own internal mirror is distorted with shame to begin with, you may mis-perceive that mirroring as reflecting something bad about you. We see only what we allow and believe ourselves to see. Part of what therapy does is change these perceptions in healthy ways. But it has the potential to feel exposing to someone who struggles with shame.

Therapists working with underlying shame issues (as is often the case with depression) should take things slow, provide emotional containment, and most importantly evoke curiousness (and even playfulness) to defuse the experience of shame in the treatment.

Read More: Where is Shame Held in the Body?

Therapy works… now make it work for you!

Hopefully, we’ve given you a feel for the pros and cons of therapy. We could have elaborated on the benefits of therapy, but they speak for themselves. We spent more time exploring possible risks of therapy because they are really interesting to think about – and because they can actually become benefits!

In a nutshell, the takeaway from this article is do your homework, talk to a few possible therapists, trust your instincts and pick someone who you feel confident is a good fit for you. That will go a long way towards predicting the outcome of your therapy. But if for some reason, it feels like something difficult or complicated is coming up in therapy, talk about it with your therapist! Chances are your therapy will actually improve and you’ll learn more about yourself. In what other endeavor can ‘pros and cons’ of therapy actually become ‘pros and pros’?