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 TREATMENTPART ONE: HOW SHAME SHOWS UP IN TREATMENT
Toxic ShameToxic Shame
Research & DefinitionsResearch & Definitions

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

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

• Individual Therapy – the client who: Individual Therapy – the client who:
  • Talks the whole sessionTalks the whole session
  • Frequently cancels sessionsFrequently cancels sessions
  • Feels bad when progress seems to have eludedFeels bad when progress seems to have eluded
  • Terminates treatment earlyTerminates treatment early
  • Deflects and projects onto othersDeflects and projects onto others
  • Relapses and does not returnRelapses and does not return
  • Minimizes problemsMinimizes problems
  • Excessively intellectualizes and analyzes treatmentExcessively intellectualizes and analyzes treatment
• Couples/Family Therapy Couples/Family Therapy
  • The attack/defend patterThe attack/defend patter
  • Anger, rage and contemptAnger, rage and contempt
  • Judgment of self and othersJudgment of self and others
  • Grandiosity, narcissism and self-inflationGrandiosity, narcissism and self-inflation
  • People pleasing and codependencyPeople pleasing and codependency
  • AvoidanceAvoidance
  • Problems with intimacyProblems with intimacy
• Group Therapy: Group Therapy:
  • Cross-talkCross-talk
  • IntellectualizingIntellectualizing
  • SilenceSilence
  • JudgmentJudgment
  • ConflictConflict

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

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

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

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

Therapeutic Strategies:Therapeutic Strategies:
Putting It All to PracticePutting It All to Practice

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