Sunday, July 03, 2011

Process Over Content: De-shaming

Let's address those questions from the last post.  In my excitement, coming back to blogging after a nice hiatus, apparently I never got to the point.  It is why therapists should shut up and listen.

The post is about blurting and embarrassment in couples therapy.  There are therapy rules, The Therapy I Ching, that predict the process of positive change.

The therapist is an authority, has proprietary knowledge, which is why she is paid the big bucks (this is surely relative and not always deserved, and sometimes no amount of money is enough, but that's another topic for another day).  As the authority, she lays down therapy basics at the beginning of treatment, and reinforces them.  One might be:
Nobody Gets Hurt Here.  
 This is the essence of the therapist/doctor/rabbi's obligation,
Do No Harm.  

Extend that obligation, Do No Harm, to everyone in the room, and we have a shot at getting something done.  We don't want anyone to become even more hurt, embarrassed, or depressed in the name of healing.  
No one should get hurt while getting better. 
Hurt can be prevented, but it isn't always, and isn't usually cause for calls to the Department of Professional Regulation.  But when someone gets hurt in therapy, it has to be discussed.

The blurt, the cause of the suffering we're talking about today, is associated with the emotional pain of a long-suffering partner.  She (for the sake of simplification, make it a she) is fed up, her angst, palpable.  It bubbles over with the blurt.  She has to inform the therapist, get to the point, how bad her partner really is.  Her partner's privacy is violated in the process.

It happens and it is a recovery moment.  To her dismay, we have to divert from content, that embarrassing thing she says he does, and roll to the process, that he has been shamed in front of the therapist.  How do you de-shame?

Embarrassment is emotional abuse.  But it isn't particularly therapeutic to tell someone, You are emotionally abusive.  Some people do come to therapy expecting a beating by the doc.  If we know that we'll gladly oblige.  For example, many who work 12-Step programs use the language: working on character defects. They see this work as laudable, the goal of all therapy, and it is incredible, great stuff.  Much healing comes from fixing ourselves, changing, becoming better people.  So people who work a program welcome criticism.

But others don't need it, not consciously, and don't come to therapy for it.  Safe to say that most of us don't want criticism and judgement in therapy. 

Yet there it is, in your office, a huge traffic accident and you have to clean up the mess.

I start with a process statement.  Process is the opposite of content.  It is the verb to the noun, the interaction.  Content is the detail.  He steals!  That's content.  She just outed him, embarrassed him.  That's process.  The therapist wants to make the process, which is usually unconscious, conscious. Anyone can deal with content.

As soon as the secret is out, the therapist gets it and directs the process. 
"What just happened there?"  

As if we didn't even know.  But we act as if, truly,  we need help here.  Help us figure out what just happened.

It is a diagnostic question, What just happened there?   We're seeking out how sensitive and how aware the patients are.  Most of the time the one who blurted will answer right away, "He's angry because I told you that he _____ (fill in the blank).  I told on him."

And the therapist can say, "He's angry?  Is it anger?  Are you sure he's angry?"

Then we can talk about emotions, which is an awesome thing to talk about in therapy.  We let this one go on, and on, and on.  When we hit embarrassment, or shame, the mother lode,  I say, "Ooh, this is a great place to go, a great thing to discuss!  Let's talk about life's embarrassing moments!  Who wants to begin?"

Silence.  Usually, if you want to think of something embarrassing, it is hard.  We repress these events, a gift.  The therapist must begin.

Since we're talking about me now, I might start them off with one of my great embarrassing moments:  Second grade. Too afraid to ask the teacher for permission to use the bathroom. 

The stuff of a reality TV show, no?  Everyone wants to join in.

The fun of disclosure, real intimacy between partners, is about to begun.



lynette said...

this happened more than once during the course of my marriage counseling years with my husband (five -- 5 -- years), during which he lied and said he didn't want things to change and wanted to stay in and love me. i reached a point where we were not going to get anywhere without the truth being out.

i think the truth is that some people do things that they SHOULD be ashamed of. shame is one emotion that can be socially beneficial. in fact, i would argue that in today's society, we are apparently not ashamed of ENOUGH. we have no shame.

shaming as a technique for manipulating someone is another thing altogether.

but should someone feel ashamed for being abusive? for lying and being deceitful? for doing those things, "knowing" they are wrong, and choosing not to change them?

i think so. sometimes there is absolutely a right and a wrong.

my husband (at some point in the not-too-distant future, my ex-husband) should be ashamed of the things he has done, and i hope he is, and that he does not sleep through the night for a decade. my anger comes from a place of terrible pain and hurt and betrayal. he is angry because i embarrassed him, but he is NOT ashamed or remorseful, because he blames it all on me.

oooh, i guess you struck a chord. i'll have to pick up the thread in my own therapy!

good to see you back!

Susie said...

Having just gone through a divorce, and coming up on a year in therapy to create a happier life for myself, I have been reading a lot of books. And the best book that I have read (I am halfway done with it) is Brene Brown's "I Thought It Was Just Me (but it isn't): Telling the Truth About Perfectionism, Inadequacy and Power." She is a shame researcher and this book is an easy reading synopsis of her and other's research on shame and it's effects on happiness, relationships, etc. She makes a very compelling argument that shaming someone does NOT improve their behavior and in fact, can make it worse,
because unlike guilt, which says "what I did was bad", shame says "I am bad". Shame "is the intensely painful
feeling or experience of believing we are flawed and
therefore unworthy of acceptance or belonging. Shame
creates feelings of fear, blame and disconnection." Dr.
Brown claims that the antidote to shame is empathy,
however, feeing shamed diminishes our ability to practice
empathy. It is a vicious cycle.

As a "blurter", I understand the need for the counselor (and
everyone else in my life) to hear how I have been
wronged. However, now that I am concentrating on my life,
my actions, and the betterment of future relationships (I do
not want to repeat my past mistakes...I want to learn from
them!), I am starting to realize the negative effects of
shame in MY life, and how my own shame led me to
shame others, including my ex-husband, and that this
ultimately contributed to our sense of disconnection, and
also to my feelings of disconnection from other people in
my life. I am also learning about shame resilience and am
soaring with happiness as I learn to not only
empathize/connect with other people, but to, most
importantly, learn to empathize and connect with the
most important person in my!

lynette said...

my husband used shaming as a way of parenting our children and blaming me for his unhappiness.

in order for someone to feel ashamed of something they did, they need to be able to recognize that what they did was wrong.

my husband is not capable, i have learned, of empathy -- at all. he is narcissistic and sees only his own needs as important. this was true when even our children were infants -- he was angered by their crying because it was disturbing his life.

i tried for years to understand and to help and i felt (and still feel) compassion for a man who is so lost inside himself he is unable to connect with others -- his relationships with his family are barely existent, and he has no friends. he minimized (and continues to minimize) the hurt he caused.

i never intended to shame him -- i wanted him to understand how much hurt he was causing. and then he did things that were in fact "shameful", beyond his nasty and mean behavior.

i am no longer interested in being in a relationship with such a man. my children are in therapy to cope with the feelings of inadequacy and low self-esteem caused by his behaviors.

i feel badly for him, but he has never felt badly about what he did. i never wanted to hurt him but he had no problem hurting me.

i see Weiner, Schwarzenegger, Edwards... society should shame these men. their actions and behaviors should be societally unacceptable. so should abuse. so should the objectification of women. how to address these? i have no idea.

a functional healthy society with positive relationships cannot exist when so many of these things are not recognized as wrong.

Anonymous said...

As the partner on the receiving end of a blurt in front of my therapist, I can tell you that whether it does harm or good depends in large measure on how the therapist responds.

In my case, the subject was our daughter, who has had serious emotional problems, most of them caused by the way we parent. Both of us, I would say my husband more than me, undermines the other by disagreeing openly about limit setting for her. She then plays the two of us off each other . . . with terrible results for her.

My husband felt compelled to repeat all of the negative things I have ever said about my daughter during a session. The vast majority of what I said was to him when she was not present, and some of it was necessary venting about dealing with a very difficult teenager.

The therapist, who is still my therapist, not a couples counselor, validated him. What good came out of it? I am more careful about what I say to him about my daughter as a result. But we never got around to looking at the dynamic causing her problems, and it remains in place today.

Actually, I need to bring this up next session. Thanks, TD, for an excellent post.

Lynn Dover said...

I missed something here. She says "He's a... (fill in the blank)." Rather than discuss his problem, you turn to discussing the emotions raised by the blurt. I see how this can help her have more empathy for how her behaviour affects him. I don't see how it makes him any less ashamed. He's still been outed. What am I missing?

Jeffrey Emery said...

Shame is a powerful emotion in that it has the capacity to make a person "stuck" or it can lead a person to change. If it does lead to change, what then, shall a person do with their shame? If they hang on to it, or if another person is able to use it as a weapon, to remind the shamed one of the situation, the hurt... has change really occurred?

Shame --> sincere change ---> forgiveness ---> redemption of a person, a relationship.


Shame --> guilt, blaming ---> cyclical anger/harmful behavior --> depression, anger and loss of relationship.

In a relationship, so much depends on the interaction, internal and external thoughts and behaviors and beliefs of each party... sometimes it is amazing that we are able to make relationships work at all...

Anna said...

The fill-in-the-blank doesn't matter, because it can be anything. Indeed, it is anything, and everything. The issue you address by dealing with the emotions is the pattern of behavior. If you address the pattern of behavior, it is likely to have a bigger, longer affect on the couple.

If he picks his nose, and they discuss the issue, he will possibly stop, but likely pick up some other issue that is infuriorating/frustrating/offensive/hurtful to his wife or boss, or children!

At least, as I see it. I am not a therapist. TD, if I'm way off, do as you wish- delete, correct, etc.

therapydoc said...

Lynette, right, talk is cheap. And some people are really all talk and too afraid to be honest, hide behind deception. They might want to change, but can't, won't. The ego can't take the hit, that admission of need to change. Too abused themselves, usually, but there might be some genetics here.

Susie, what a marvelous comment, thank you so much. I've heard that's a good book. But to literally hear you grow, just music.

Anon, that just kills me. Not that you became the patient, because sometimes a therapist sees one partner as immovable and will work with the healthier other, but that the system of parenting hasn't budged. Yes, ask her how you can approach him to make some slight "adjustments".

Lynn, he's ashamed because he should be, probably, and a little shame isn't the problem in therapy, it's the process of communication. We'll deal with the shame, but the communication is what is repeated over and over again. So the process has to change before anyone's shame ever will. Let the therapist work on the deeper problems, the reasons people steal, lie, etc. The partners generally are overwhelmed and already victimized to be able to have any effect upon "shameful" behavior.

Lovin', I really like that. Thanks!

Anna, not way off for some people, but applies to someone who isn't already committing to the possibility, at least, of positive change. Thee person you're talking about is not the person who is working on himself in therapy. In the original post we were talking about a person who really was working on himself, and then his spouse, whose anger had bubbled up, couldn't help but be sure that indeed, the therapist got it. It happens a lot.

Anna said...

Thanks, TD. Possibly, a little projection there, of course. ;)

Certainly, then, if the person is committed to doing the work, a blurt would be more shaming than the person I mention, who is possibly ignoring the issue.

therapydoc said...

You got it, Anna.

Counseling Services CA said...

Same as mien.I have same experience I done first Counseling for Marriage counseling.Really I memorized that day again today from your post.thanks for posting your experience with us.

Mound Builder said...

therapydoc said:
"...because sometimes a therapist sees one partner as immovable and will work with the healthier other,..."

How do you ensure that the healthier one doesn't end up feeling that he/she is the problem? I'm imagining that if the healthier, movable one is the one you work with, the healthier one might end up noticing he/she is the one you keep working with, moving toward change, and might get the idea that he/she is the sicker one because you've focused on him/her.

therapydoc said...

It's an art, I tell ya'. The point is that we de-pathologize, normalize, universalize, and de-shame no matter who we're working with. Part of the art is knowing that the "healthy" partner at some point is beginning to feel unwell in the role of patient.

When I said sometimes a therapist-- I didn't say, Me. Generally I see the system and work with each partner to discover different steps, different behaviors. That can be in individual or couple therapy, but there will be work with both of them, sometimes down to the signing of the papers, if that's what they want in the end. And it usually isn't, but sometimes, it is.

Tzipporah said...

Yes, but what ABOUT the stealing/gambling/whatever? Does that ever go on the table, or is it all about feelings?

I'm also curious about the OA/UA thing, which you mentioned in the previous post but never went back to.

Tzipporah said...

OK, so I just went and googled over-adequate/under-adequate. Very interesting, since the discussions seem to assume that the underlying causes are voluntary - one person chooses to do less, the other chooses to do more. How does relationship therapy work with such couples when there's a real underlying issue, like chronic illness? Or maybe such couples don't have enough time and energy to get to therapy... ;)

therapydoc said...

Whoa. First about the gambling, stealing, etc. Can't change someone who doesn't want to change, but that said, the job of the therapist is to make people want to change. We do that in many, many ways, always using our relationship with the patient as a hook. People change for people they respect. Sometimes.

Sure, we can talk more about OA-UA. We have in many posts without ever labeling it as such. The codependent relationships are often OA-UA. Don't know when we'll get to it. One day.

Better Things-- Seeing Ghosts