The reason hypnosis works to relieve a wide variety of mental and physical problems is that all physical and mental experiences and behaviors, whether they are conscious or unconscious, psychogenic or resulting from physical injury or illness, follow nerve transmissions in the brain. The pathways of these nerve signals can be altered by suggestion when the brain is in an alpha or theta brain wave state. These are the brain wave states that lie between sleeping and waking consciousness.
The task of the hypnotherapist is to activate these naturally occurring brain wave states. The subconscious and unconscious functions of mind are more susceptible to suggestion in these states, so that healing patterns of response can be suggested, practiced and established as an automatic response to a specific experience.
For example, a stress response to job-hunting can change to one of relaxed confidence. Another example is the experience of pain, which can be modified by being blocked or changed via establishing a new neuron pathway, so that the sensation of pain becomes a sensation of warmth, or a slight itch.
While it is the hypnotherapist who speaks the words that induce the alpha or theta brain wave state and and makes the suggestions to set up a new pattern of response, it is the client who determines what the new response will be. Hypnotherapy offers many methods to go about making changes, and a well-educated hypnotherapist knows how to interview a client to determine which combination of methods would be most comfortable and healing for each individual client.
While a hypnotherapist can neither diagnose nor treat medical conditions, clients can use a hypnotherapist's skills to change their automatic responses to conditions that their physicians have already diagnosed, assisting whatever treatments clients' physicians have prescribed. Hypnotherapists work alongside doctors to reduce or transform sensations of pain and can prepare clients for surgery and childbirth ahead of time by teaching them self-hypnosis and giving suggestions for rapid healing after surgery. These same hypnotherapy methods can be used in addition to physicians' treatments for conditions that cannot be addressed with surgery. Hypnotherapy can also be used by clients to augment medical treatment of psychiatric issues.
Enlisting the immense strength and unwavering focus of the subconscious mind can strongly enhance a client's psychological and physical health. However, the only effects produced by hypnosis are those the client agrees are beneficial because the subconscious mind will only accept that which it has already determined is acceptable. In addition, a reputable hypnotherapist will thoroughly discuss and review the suggestions to be made with the client beforehand.
Source: American Association of Professional Hypnotherapists
Friday, July 30, 2010
Wednesday, June 9, 2010
How Shame and Toxic Guilt inhibit Change
I recently conducted two trainings on the subjects of shame and change. One of the trainings was through LDS Family Services and the other was with the Dept of Child and Family Services through the State of Utah. This is the research which goes with the presentation. Much of this research correlates with concepts which are found in my book "Healing Secrets". I had many people from the two trainings ask me to expound on the concepts I introduced there. Here is the response:
SHAME AND GUILT
Recent work on the psychological distinctions between shame and guilt has important implications for mental health counselors. In particular, the work of Lewis (1971) and Tanguey (1990, 1995; Tangney & Dearing, 2002) identifies psychological differences between shame and guilt and how they are phenomenologically expressed that provides helpful insight to those working with clients experiencing these emotions. This paper draws upon this work to establish criteria for distinguishing shame and guilt and to offer guidelines for their treatment.
Distinctions between shame and guilt are often overlooked by those in clinical work (Tangney & Dearing, 2002). Particularly in Western culture, they are often assumed to be interchangeable or synonymous terms (Gilbert, Pehl, & Allan, 1994). Erik Erikson (1950), one of the first to distinguish psychologically between shame and guilt, noted that "shame is an emotion insufficiently studied, because in our civilization it is so easily absorbed by guilt" (13. 252; cf. Lansky, 1995).
This failure to adequately distinguish shame from guilt ignores a growing body of research on important psychological differences between these two emotions (Tangney & Dearing, 2002). Especially noticeable is the absence of studies that explore the implications of these differences for counseling. Research exploring the psychological differences between shame and guilt notes that failure to distinguish between the two emotions contributes to the neglect of shame as a significant clinical problem (Capps, 1993; Konstam, Chernoff, & Deveney, 2001; Tangney & Dearing); furthermore, shame is often mistaken for guilt, leading to ineffective treatment for those suffering from shame (Lewis, 1971; Nathanson, 1992; Tangney, 1996; Tangney & Dearing; Tangney, Miller, Flicker, & Barlow, 1996). These problems are likely to increase, given the conclusion of several notable authors that shame, not guilt, is now the prominent emotion troubling Western culture (Scheff, 1995; Tanguey et al., 1996; cf. Capps, 1993; Cheng & Page, 1995; Fowler, 1996; Kaufman, 2004).
Although shame and guilt show considerable overlap, often appearing together in clients (Tangney & Dearing, 2002), there is a heuristic as well as practical clinical value in reflecting on the differences. This paper reviews recent research on the psychological and phenomenological characteristics of shame as distinguished from guilt. It summarizes important distinctions between the two emotions and how they are experienced. It then outlines the implications of the differences for counseling.
Mental health counselors will especially be interested in the research on differences between shame and guilt because it helps highlight the developmental and growth aspects of these emotions, not simply the life difficulties that may accompany them. Attending to the developmental differences is especially important in formulating treatment goals and strategies.
DISTINGUISHING SHAME AND GUILT PSYCHOLOGICALLY
Erik Erikson (1950) made one of the first psychological distinctions between shame and guilt. His lifespan model outlined the growth of the self, both body and psyche, as it occurs in the context of expanding social interactions. He laid out critical tasks of emotional development occurring throughout the lifespan that promote healthy psychosocial growth. In Erikson's model, growth occurred through balancing the tension produced by certain polarities. However, this is not an even balance of polarities; although both polarities are necessary, health required an "overbalance" of the positive quality. The resolution of each crisis produced an ego strength that was integrated into one's emerging identity and helped one face the tasks of the next developmental stage. Erikson's list of critical tasks included articulation of the development of shame and guilt.
For Erikson (1950), shame preceded guilt developmentally. As with all the critical tasks, without a proper balance of the polarities one did not proceed well to the next task. This meant that without a proper measure of shame, neither guilt nor initiative developed appropriately. However, if there was too much shame, initiative and guilt were overshadowed by compulsive activity. Since shame was connected to the development of autonomy and the ego quality of will, an overbalance of shame and doubt (vs. autonomy with the optimal amount of shame and doubt) resulted in compulsive activity as the ego overcompensated in its attempts to master and manage the expressions of will. By contrast, guilt was associated with initiative and the emerging ego quality of purpose. An overbalance of guilt, instead of an optimal level of guilt with an overbalance of initiative, inhibited productivity and left the person lacking in purposeful drive toward future goals.
Since Erikson (1950), there has been considerable work, both theoretical and empirical, on the psychological distinctions between shame and guilt. Over the past three decades, Helen Block Lewis's distinction (1971) between shame and guilt has emerged as one of the dominant conceptualizations, in large part because it has received strong empirical support from a range of both quantitative and qualitative studies (Gilbert, Pehl, & Allan, 1994; Konstam et al., 2001; Tangney, 1990, 1991, 1995, 1996; Tangney & Dearing, 2002; Tangney, Miller, Flicker, & Barlow, 1996; Tangney, Wagner, Fletcher, & Gramzow, 1992; Tangney, Wagner, Hill-Barlow, Marschall, & Gramzow, 1996; Tracy, Robins, & Tangney, 2007). Lewis's theory and the empirical work it has inspired provide important groundwork for distinguishing shame and guilt psychologically. She articulated cognitive, affective, and motivational differences between shame and guilt that empirical studies have verified (see Tangney & Dearing, 2002, for a summary). Thus it is possible to define certain psychological markers that differentiate shame and guilt.
Cognitive Differences
One of Lewis's major contributions (1971) was to refute earlier social theories (e.g., Benedict, 1946) that described shame as a public emotion and guilt as a private one (Tangney, 1995). Lewis theorized that although the same situation could elicit shame in one person and guilt in another, the differentiating factor was the individual's interpretation of the role of the self in these situations, not whether the experience took place publicly or privately. This different way of seeing the self pointed to cognitive differences in the experiencing of shame and guilt. With guilt, the self was pronouncing judgment on its activity; with shame, the self pronounced a more summary judgment on the inadequacy of the self itself. As Lewis noted:
The experience of shame is directly about the self, which is the
focus of evaluation. In guilt, the self is not the central object
of negative evaluation, but rather the thing done or undone is the
focus. In guilt, the self is negatively evaluated in connection
with something but is not itself the focus of the experience (p.
30).
One might say that the cognitive self-awareness attendant on shame is more encompassing than with guilt. According to Lewis, shame involved more self-consciousness, self-imaging, and greater body awareness than guilt. Similarly, persons experiencing shame seem less able to cognitively sort out their actions from the more fundamental sense of self.
In addition to greater cognitive self-awareness, there were cognitive differences in qualities attributed to the self. Those experiencing shame tended to see themselves as worthless and powerless--unable to make changes in the environment or themselves. By contrast, those experiencing guilt saw themselves as able to take some sort of corrective action either toward the consequences of their behavior or toward future behavior (Tangney & Dearing, 2002; cf. Andrews, Qian, & Valentine, 2002; Efthim, Kenny, & Mahalik, 2001; Konstam et al., 2001).
Another aspect of the cognitive differences between shame and guilt concerned where the sense of evaluation seemed to originate. In shame, the source of blame or negative valuation of the self was localized as "out there," originating in the "other." This externalizing of blame was one of the chief markers of shame (Tangney & Dearing, 2002; Tangney et al., 1992, 1996). Even as an internal experience shame involved judgment of an internalized "disapproving other." With guilt, by contrast, the internal evaluation system was felt to originate more from within a person's own sense of self.
Affective Differences
There also are affective markers that distinguish shame and guilt. Using Lewis's (1971) theoretical distinctions Tangney (1990, 1995, 1996) has developed an instrument (the TOSCA--Test of Self-Conscious Affects) for measuring and distinguishing shame and guilt. Her work with this instrument has verified cognitive, affective, and motivational distinctions between the two emotions that can distinguish them. Following Lewis, Tangney concurred that the chief cognitive differ, race between shame and guilt was how the self was perceived, but she also pointed to affective differences between them.
Lack of empathy. One of Tangney's (1991; Tanguey & Dearing, 2002) central findings was that empathy was a key marker for differentiating shame from guilt. This finding derived from Lewis's (1971) point that shame involves a more global evaluation of the self than did guilt. True interpersonal guilt (feeling bad when one was aware of doing someone harm) hinged on (a) an empathic awareness of and response to someone's distress and (b) an awareness of being the cause of that distress. From this perspective, empathy was an essential prerequisite for guilt (Tangney; cf. Konstam et al., 2001; Leith & Baumeister, 1998). According to Tangney, it was the absence of empathy that was striking about the presence of shame. Tangney theorized that this might be because shame is such a painful and overwhelming experience that it naturally draws the focus away from the distressed other back to the self. Even when a shame-prone individual noticed and initially empathized with another, his or her empathic response might become short-circuited. "When faced with a distressed other, shame-prone individuals may be particularly likely to respond with a personal distress reaction, in lieu of a true empathic response" (Tangney, p. 600). This preoccupation with the self is'inconsistent with the other-oriented nature of empathy.
Anger and aggression. Another distinction is the link between shame, aggression, and anger that Tangney has demonstrated (Tangney, 1996; Tangney & Dearing, 2002; Tangney, Miller, Flicker, & Barlow, 1996; Tangney et al., 1992). This connection could take an active or passive form as the shamed individual attempted to manage his or her feelings. The more passive route was associated with anger turned inward (a ruminative, unexpressed anger), self-directed hostility, and a tendency to withdraw from anger-related situations. The more active route involved reactivating the impaired self through other-directed anger (e.g., by turning the tables and externalizing blame onto others involved in the shame-eliciting situation). For those who took a more active response, proneness to shame is associated with malevolent and fractious intentions and a likelihood of engaging in all manner of direct, indirect, and displaced aggression (Tangney & Dearing; Tangney et al., 1996).
By contrast, guilt-prone individuals were not disposed particularly to blame external factors or other people for negative events. Rather, when experiencing guilt they were likely to become aware of their role in negative interpersonal situations, and by extension felt an obligation to assess their impact on others. Thus, guilt produced a sense of tension and regret borne of empathy, which often led to reparative action such as confession, apology, or making amends (Tangney, 1996; Tangney & Dearing, 2002; cf. Konstam et al., 2001).
Motivational Differences
The movement toward reparative action provides a motivational marker for distinguishing shame and guilt. Shame involves a withdrawing from others--a shrinking or hiding, especially from shame-eliciting situations. Shame moves one away from others, perhaps through passive withdrawal or the externalization of blame. Guilt, on the other hand, moves one toward others in attempts to repair damage done, often through confession and restitution. Those experiencing guilt take responsibility for their actions and the consequences; the shame-prone person, unable to take responsibility, typically shifts the blame to another person (Tangney & Dearing, 2002; cf. Leith & Baumeister, 1998).
Thus, shame and guilt are experienced very differently, in terms of both thoughts and feelings as well as in behavioral motivations. As Tangney (1991) summarized it:
Because of its focus on specific and presumably controllable
behaviors, the guilt experience is uncomfortable but not
debilitating. That is, the self remains "able." Not surprisingly,
phenomenological reports indicate that guilt's consequent
motivation and behavior tends to be oriented toward reparative
action. Shame, on the other hand, is a much more global, painful,
and devastating experience in which the self, not just behavior, is
painfully scrutinized and negatively evaluated. This global
negative affect is often accompanied by a sense of shrinking and
being small, and by a sense of worthlessness and powerlessness.
Phenomenological data also suggest that shame is likely to be
accompanied by a desire to hide or to escape from the interpersonal
situation in question (p. 599).
Tangney and Dearing (2002) further concluded that guilt as the more adaptive of the two emotions was the more developmentally mature emotion to move people toward.
IMPLICATIONS OF THESE DISTINCTIONS FOR MENTAL HEALTH COUNSELING
Although shame and guilt often occur together, the distinctions described provide not only a means for determining whether shame or guilt is the dominant presenting emotion but also offer suggestive lines for the treatment of shame vs. guilt. These two emotions are not only significantly different in a client's experience, they also reflect differences in developmental and coping abilities. Being able to distinguish shame from guilt will help mental health counselors to offer interventions more appropriate to the experience of each emotion.
Criteria for Distinguishing Shame and Guilt
Since shame and guilt are easily confused because they often co-occur (Lewis, 1971; Nathanson, 1992; Tangney & Dearing, 2002), the first way the distinctions noted are helpful for the counselor is in providing criteria for determining whether a person is struggling more with shame or guilt. Since treatment for the two emotions differs (see below), there are several things to listen for or attend to in a client's presentation to help sort out which is dominant.
The "self' vs. the "thing done. "" From Lewis (1971), one would conclude that if the presentation of a problem is focused on a global sense of the person's badness rather than feeling bad about a specific action, then shame more than guilt is the central emotion. Conversely, guilt dominates when the concern is over the thing done rather than the self. This distinction is important diagnostically because a client who can judge his or her actions is at a different place developmentally from one who makes global condemnations of the self. The former has a clear, stable sense of self; the latter has a more tentative, diffuse sense of self.
This difference in the stability and cohesiveness of the self shows up in therapy in various ways. For instance, a guilt-laden depression would be evident in talk about actions taken or not taken, while a shame-laden depression would be characterized by reports of worthlessness or badness of the person (the self) rather than the deeds. Similarly, anxiety in a guilt-prone person would derive from an awareness of others and the harm done to them (e.g., the person is anxious about a mistake that has or will cause others to suffer). Anxiety connected to shame, however, would reflect a concern not with the other but with the self. Thus, the shame-prone person might be anxious because of a fear of being found out and judged (for a violation of standards and expectations either of one's own or others) or a fear of being asked to do things that would reveal one's deficiencies.
Boundary issues and compulsions. Erikson's (1950) placement of shame in a developmental conflict over autonomy suggests that the dominant emotion can be discerned through struggles over boundary issues and compulsions. For instance, clients who show no discretion in the choice of friends or indiscriminately let others take advantage of their good will are likely suffering from a deep sense of shame rather than guilt, which is connected to the less stable sense of self that is characteristic of a shame-dominated person. Because of the more diffuse boundaries to the self, the shame-prone person also might express a fear of intimacy as potentially engulfing. By contrast, the guilt-prone person with a clearer sense of self is not as fearful of the painful interaction with others that often accompanies having done wrong. The guilt-prone person has less fear of interaction because there is no concomitant fear that somehow the self will be overwhelmed or crushed in the exchange.
Boundary issues are discerned not only in concerns with their permeability but also through their rigidity and compulsivity. Learning boundaries (what is permitted or not; where self and other start and end), Erikson (1950) argued, develops the ego capacity of will. Compulsions would indicate deficiencies in ego capacity; the person feels less in control of thoughts or behaviors. Thus, a shame-dominated client will describe addictive behavior (e.g., gambling, alcohol, drugs) as simply his or her nature, something that cannot be controlled. Such a client, stuck in ruminations over how bad he or she is, would be paralyzed and unable to take reparative action. A guilt-dominated client is apt to describe these behaviors as bad choices, something for which he or she needs to make amends.
A different kind of compulsivity and rigidity can be seen in the perfectionist who compensates for a general lack of control by circumscribing a particular area for managing well. Such a person could be considered as struggling more with shame than with guilt. Similarly, the compulsive part of an obsessive-compulsive ritual is often a means of trying to regain control. Ironically, the absence of control over compulsive behavior often brings a greater sense of shame (cf. Carnes's [1983] description of the despair that follows acting out in an addiction cycle).
Although compulsive behavior occasionally can point to guilt (cf. Lady Macbeth's hand washing), Erikson (1950) would help the counselor appreciate compulsions as more a struggle over loss of control or will and thus more shame-based. Conversely, the client who struggles with guilt more than shame is more aware of what he or she can or cannot "do" (i.e., issues of initiative and sense of purpose).
Lack of empathy. Tangney's (1991) work elaborated how the diffuse global evaluation of one's badness that distinguished shame from guilt often manifested as a preoccupation with the self, with a concomitant inability to express empathy for others. Thus, a lack of empathy points to a dominance of shame over guilt (Tangney & Dearing, 2002).
Lack of empathy is connected to developmental deficits in the formation of the self (see above). By contrast, when guilt predominates, there is an ability to empathize and an appropriate concern for damage to the relationship or reparation of the other's loss. Thus, anxiety that derives from a client's ability to see the impact of his or her behavior on others is indicative of guilt. Shame-based anxiety might be characterized by a desire that others see how debilitating the anxiety is for the client and how in need of care the client is.
Blaming and anger. Tangney and Dearing (2002) also pointed to the distinguishing markers of externalizing blame and excessive anger (either internalized or projected outward) as markers that can alert the counselor to the potential dominance of shame. When in describing a problem a person focuses on the fault of another rather than his or her own role in the problem, shame may be more prevalent than guilt. Blaming others is a way of defending against the global, negative evaluation of the self (cf. Nathanson, 1992). Thus, a spouse who has trouble seeing his or her part in the creation of the marital tension or a client who thinks his or her anger is due to the actions of others is likely suffering from a deep sense of shame. The guilt-prone person is more accurately able to accept his or her role in relational problems.
However, the mental health counselor also must remember that some clients will turn the anger and blame inward. The client characterized by a global self-loathing may appear to acknowledge fault but then uses this acknowledgement as an excuse to avoid action. Having declared how bad one is, responsibility is shifted to the other. Where guilt is more dominant, each partner not only can hear the other's side more readily but is in a better place to take restorative steps.
Withdrawal. Both Erikson (1950) and Tangney (Tangney et al., 1996) have noted that a marker for the dominance of shame over guilt is withdrawal from others, which may take the active form of blaming others. Blaming, with its attendant anger, creates distance from others, thus achieving the goal of withdrawal. However, the counselor also must be aware that withdrawal may take a more passive route of isolation from others: Given the global, negative self-evaluation, a client may withdraw out of the conviction that others would not wish to associate with someone so blameworthy. Self-blame as an excuse for lack of action can be another way clients withdraw. By contrast, when guilt is the dominant emotion, the person is more likely to move toward others by making reparative gestures.
Treatment Differences
The characteristic distinctions between shame and guilt also point to important differences in treatment approach. Since shame and guilt often occur together, both will need a response but the proper response to each will differ. Developmental differences in the growth and stability of the self require treatments that take this trajectory into account. When dealing differentially with these two emotions, the focus, the goal, and the modality of the intervention will vary.
Focus of the intervention. When shame is the dominant emotion, the experiences rather than the actions of the self become the focus of interventions. Before someone overwhelmed with shame can properly evaluate the actions of the self, the person must come to grips with the more global negative evaluation of the self. Similarly, before the person overwhelmed by shame can have empathy for another's distress, the distress of the shame-filled person's sense of fundamental flaw must be addressed.
What this suggests in terms of treatment is an approach sensitive to the insight that developmentally shame precedes guilt. When issues of shame and the self lie behind a client's dysfunction, focusing on behavioral change to assuage guilt not only produces results that may be less than satisfactory but is apt to exacerbate feelings of shame. In fact, a counselor might discern when shame is the dominant emotion when a person engages (often repeatedly) in guilt remedies such as confession and forgiveness but finds no sense of relief.
For instance, those suffering from shame are sometimes counseled toward confession and forgiveness--appropriate responses to guilt, but premature or ineffective responses to shame. Forgiveness as an intervention for the guilt-prone is effective because there is a cohesive sense of self that can empathize (cf. McCullough, Worthington, & Rachal, 1997). For the shame-prone, thinking of forgiveness feels like a loss to the self, an invalidation of his or her wound. Even when the shame-prone person expresses a need to forgive, there is a self-focus to the motivation: For example, forgiving is a way to feel magnanimous or to be released from the added shame of not being a forgiving person.
Goals of the intervention. The developmental distinction between shame and guilt means the mental health counselor also must think developmentally about the goals of counseling. For instance, when shame is the dominant emotion, the goal becomes strengthening the self (e.g., helping the person learn to distinguish self from behaviors) as a necessary step to helping move the person toward ability to empathize with the other. Since shame short-circuits empathic response, because the person is too preoccupied with judging his or her flawed nature to attend to the feelings of others, counseling needs to focus first on creating a safe, nonjudgmental context in which a self overwhelmed with shame can relax the defenses that belong to such self-judgment. Far from encouraging the self-absorption that accompanies shame, this aspect of counseling becomes a necessary step in nurturing the ego capacity that makes the next developmental step successful (cf. Erikson, 1950).
Counseling that is sensitive to the developmental relation between shame and guilt will see growth emerging in separate steps. Although the penultimate goal of counseling with those experiencing shame will be to strengthen the self overcome by its sense of being flawed, the ultimate goal with such a client would be to strengthen the self so that it might move toward guilt--that is, toward a response in which the self can see itself as acting badly, see the consequences of its actions, take responsibility for its actions, and move toward reparation in relationships rather than being stuck in self-loathing about feeling essentially and fundamentally flawed (Tangney & Dearing, 2002). Such self-preoccupation actually keeps one distant from others and unable to attend to how one's action affects the other.
Modality of the intervention. Not only must the focus and goal of the intervention be different for shame vs. guilt, its modality must be adapted as well. Since developmentally shame precedes guilt, it involves a different level of ego functioning. Conceptually shame might need more supportive or relationally oriented counseling; guilt would respond to more traditional insight or behavioral change counseling approaches. Behavioral interventions focused on things done, which might work well with guilt, need to give way to relationship building when shame dominates and the self needs strengthening. This is not to say that behavioral treatment will have no impact on shame issues, but it does argue that a shame-based person requires a qualitatively different kind of relational encounter than a guilt-based person. A shame-based person seems to need to experience affirmation and acceptance in the interchange with another, while a more cognitive verification or acknowledgement of the other's forgiveness seems to facilitate release of guilt. There is a subtle yet vital difference in these interactions. In actual practice, of course, for a number of reasons counselors find themselves moving back and forth between supportive and insight-oriented comments, but in this context it may be seen as an aspect of the fact that clients often bring guilt overlaid with shame to counseling (Tangney & Dearing, 2002).
When shame is more dominant than guilt, the client might be expected to be motivated to conceal issues due to fear of a negative evaluation from the counselor that would mirror the client's negative self-evaluation and heightened sensitivity to the thoughts of a projected disapproving other (Tangney & Dearing, 2002). Such negative expectations can impact the quality of the therapeutic relationship (i.e., "transference") and the client's ability to benefit (Gilbert, Pehl, & Allan, 1994). Attending to the quality of the relationship (e.g., negative transference) can open up opportunities for acknowledgement and exploration of shame. Mental health counselors can help those experiencing shame to move toward understanding what these experiences can teach about self and relationships by providing a safe, nonretaliating alternative to self-condemnation and the anticipated judgment from the counselor as disapproving other. This new kind of relationship can provide a foundation for and example of further development of empathy and guilt.
CONCLUSION
Recent literature, both theoretical and empirical, has verified that shame is an emotion distinct from guilt. However, a significant trend in clinical work has been to subsume shame under guilt, to treat it as secondary, or not to recognize it as an important, even key, emotion in its own right. Even though shame is a prominent emotion in our culture, current treatments often focus on modalities that are premature, ineffective, and sometimes harmful to those whose issues revolve around shame rather than guilt. We have argued for the need to recognize the psychological differences between shame and guilt so as to better distinguish and treat those suffering with these emotions. Although both often appear together in clients (to greater or lesser degrees), being able to distinguish between them has both heuristic and practical clinical value.
REFERENCES
Andrews, B., Qian, M., & Valentine, J. (2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology, 41, 29-42.
Benedict, R. (1946). The chrysanthemum and the sword. Boston: Houghton Mifflin.
Capps, D. (1993). The depleted self: Sin in a narcissistic age. Minneapolis, MN: Fortress Press.
Carnes, P. (1983). Out of the shadows. Minneapolis, MN: CompCare Publishers.
Cheng, H., & Page, R. (1995). A comparison of Chinese (in Taiwan) and American perspectives of love, guilt, and anger. Journal of Mental Health Counseling, 17, 210-219.
Efthim, P., Kenny, M., & Mahalik, J. (2001). Gender role stress in relation to shame, guilt and externalization. Journal of Counseling and Development, 79, 430-438.
Erikson, E. (1950). Childhood and society. New York: W.W. Norton & Company.
Fowler, J. (1996). Faithful change: The personal and public challenges of postmodern life. Nashville, TN: Abingdon Press.
Gilbert, P., Pehl, J., & Allan, S. (1994). The phenomenology of shame and guilt: An empirical investigation. Journal of Medical Psychology, 67, 23-26.
Kaufman, G. (2004). The psychology of shame: Theory and treatment of shame-based syndromes (3rd ed.) New York: Springer Publishing Company, Inc.
Konstam, V., Chemoff, M., & Deveney, S. (2001). Toward forgiveness: the role of shame, guilt, anger and empathy. Counseling and Values, 46, 26-39.
Lansky, M. (1995). Shame and the scope of psychoanalytic understanding. American Behavioral Scientist, 38, 1076-1090.
Leith, K., & Baumeister, R. (1998). Empathy, shame, guilt, and narratives of interpersonal conflict: Guilt-prone people are better at perspective taking. Journal of Personality, 66, 1-37.
Lewis, H. (1971). Shame and guilt in neurosis. New York: International Universities Press.
McCullough, M., Worthington, E., & Rachal, K.(1997). Interpersonal forgiving in close relationships. Journal of Personality and Social Psychology, 73, 321-336.
Nathanson, D. (1992). Shame and pride: Affect, sex, and the birth of the self. New York: W.W. Norton & Company.
Scheff, T. (1995). Shame and related emotions: An overview. American Behavioral Scientist, 38, 1053 1059.
Tangney, J. (1990). Assessing individual differences in proneness to shame and guilt: Development of the self-conscious affect and attribution inventory. Journal of Personality and Social Psychology, 59, 102-111.
Tangney, J. (1991). Moral affect: The good, the bad, and the ugly. Journal of Personality and Social Psychology, 61, 598~507.
Tangney, J. (1995). Recent advances in the empirical study of shame and guilt. American Behavioral Scientist, 38, 1132-1145.
Tangney, J. (1996). Conceptual and methodological issues in the assessment of shame and guilt. Behavioral Research and Therapy, 34, 741-754.
Tangney, J., & Dearing, R. (2002). Shame and guilt. New York: Guilford Publications.
Tangney, J., Miller, R., Flicker, L., & Barlow, D. (1996). Are shame, guilt, and embarrassment distinct emotions? Journal of Personality and Social Psychology, 70, 1256-1269.
Tangney, J., Wagner, P., Fletcher, C., & Gramzow, R. (1992). Shamed into anger? The relation of shame and guilt to anger and self-reported aggression. Journal of Personality and Social Psychology, 62, 699~75.
Tangney, J., Wagner, P., Hill-Barlow, D., Marschall, D., & Gramzow, R. (1996). Relation of shame and guilt to constructive versus destructive responses to anger across the lifespan Journal of Personality and Social Psychology, 70, 797-809.
Tracy, J., Robins, R., & Tangney, J. (Eds.) (2007). The self-conscious emotions: Theory and research. New York: Guilford Press.
Stephen Parker is affiliated with Regent University. Rebecca Thomas is in private practice in Norfolk, Virginia. Correspondence concerning this article should be addressed to Stephen Parker, 1000 Regent University Drive, Virginia Beach, VA 23464. E-mail: steppar@regent.edu.
SHAME AND GUILT
Recent work on the psychological distinctions between shame and guilt has important implications for mental health counselors. In particular, the work of Lewis (1971) and Tanguey (1990, 1995; Tangney & Dearing, 2002) identifies psychological differences between shame and guilt and how they are phenomenologically expressed that provides helpful insight to those working with clients experiencing these emotions. This paper draws upon this work to establish criteria for distinguishing shame and guilt and to offer guidelines for their treatment.
Distinctions between shame and guilt are often overlooked by those in clinical work (Tangney & Dearing, 2002). Particularly in Western culture, they are often assumed to be interchangeable or synonymous terms (Gilbert, Pehl, & Allan, 1994). Erik Erikson (1950), one of the first to distinguish psychologically between shame and guilt, noted that "shame is an emotion insufficiently studied, because in our civilization it is so easily absorbed by guilt" (13. 252; cf. Lansky, 1995).
This failure to adequately distinguish shame from guilt ignores a growing body of research on important psychological differences between these two emotions (Tangney & Dearing, 2002). Especially noticeable is the absence of studies that explore the implications of these differences for counseling. Research exploring the psychological differences between shame and guilt notes that failure to distinguish between the two emotions contributes to the neglect of shame as a significant clinical problem (Capps, 1993; Konstam, Chernoff, & Deveney, 2001; Tangney & Dearing); furthermore, shame is often mistaken for guilt, leading to ineffective treatment for those suffering from shame (Lewis, 1971; Nathanson, 1992; Tangney, 1996; Tangney & Dearing; Tangney, Miller, Flicker, & Barlow, 1996). These problems are likely to increase, given the conclusion of several notable authors that shame, not guilt, is now the prominent emotion troubling Western culture (Scheff, 1995; Tanguey et al., 1996; cf. Capps, 1993; Cheng & Page, 1995; Fowler, 1996; Kaufman, 2004).
Although shame and guilt show considerable overlap, often appearing together in clients (Tangney & Dearing, 2002), there is a heuristic as well as practical clinical value in reflecting on the differences. This paper reviews recent research on the psychological and phenomenological characteristics of shame as distinguished from guilt. It summarizes important distinctions between the two emotions and how they are experienced. It then outlines the implications of the differences for counseling.
Mental health counselors will especially be interested in the research on differences between shame and guilt because it helps highlight the developmental and growth aspects of these emotions, not simply the life difficulties that may accompany them. Attending to the developmental differences is especially important in formulating treatment goals and strategies.
DISTINGUISHING SHAME AND GUILT PSYCHOLOGICALLY
Erik Erikson (1950) made one of the first psychological distinctions between shame and guilt. His lifespan model outlined the growth of the self, both body and psyche, as it occurs in the context of expanding social interactions. He laid out critical tasks of emotional development occurring throughout the lifespan that promote healthy psychosocial growth. In Erikson's model, growth occurred through balancing the tension produced by certain polarities. However, this is not an even balance of polarities; although both polarities are necessary, health required an "overbalance" of the positive quality. The resolution of each crisis produced an ego strength that was integrated into one's emerging identity and helped one face the tasks of the next developmental stage. Erikson's list of critical tasks included articulation of the development of shame and guilt.
For Erikson (1950), shame preceded guilt developmentally. As with all the critical tasks, without a proper balance of the polarities one did not proceed well to the next task. This meant that without a proper measure of shame, neither guilt nor initiative developed appropriately. However, if there was too much shame, initiative and guilt were overshadowed by compulsive activity. Since shame was connected to the development of autonomy and the ego quality of will, an overbalance of shame and doubt (vs. autonomy with the optimal amount of shame and doubt) resulted in compulsive activity as the ego overcompensated in its attempts to master and manage the expressions of will. By contrast, guilt was associated with initiative and the emerging ego quality of purpose. An overbalance of guilt, instead of an optimal level of guilt with an overbalance of initiative, inhibited productivity and left the person lacking in purposeful drive toward future goals.
Since Erikson (1950), there has been considerable work, both theoretical and empirical, on the psychological distinctions between shame and guilt. Over the past three decades, Helen Block Lewis's distinction (1971) between shame and guilt has emerged as one of the dominant conceptualizations, in large part because it has received strong empirical support from a range of both quantitative and qualitative studies (Gilbert, Pehl, & Allan, 1994; Konstam et al., 2001; Tangney, 1990, 1991, 1995, 1996; Tangney & Dearing, 2002; Tangney, Miller, Flicker, & Barlow, 1996; Tangney, Wagner, Fletcher, & Gramzow, 1992; Tangney, Wagner, Hill-Barlow, Marschall, & Gramzow, 1996; Tracy, Robins, & Tangney, 2007). Lewis's theory and the empirical work it has inspired provide important groundwork for distinguishing shame and guilt psychologically. She articulated cognitive, affective, and motivational differences between shame and guilt that empirical studies have verified (see Tangney & Dearing, 2002, for a summary). Thus it is possible to define certain psychological markers that differentiate shame and guilt.
Cognitive Differences
One of Lewis's major contributions (1971) was to refute earlier social theories (e.g., Benedict, 1946) that described shame as a public emotion and guilt as a private one (Tangney, 1995). Lewis theorized that although the same situation could elicit shame in one person and guilt in another, the differentiating factor was the individual's interpretation of the role of the self in these situations, not whether the experience took place publicly or privately. This different way of seeing the self pointed to cognitive differences in the experiencing of shame and guilt. With guilt, the self was pronouncing judgment on its activity; with shame, the self pronounced a more summary judgment on the inadequacy of the self itself. As Lewis noted:
The experience of shame is directly about the self, which is the
focus of evaluation. In guilt, the self is not the central object
of negative evaluation, but rather the thing done or undone is the
focus. In guilt, the self is negatively evaluated in connection
with something but is not itself the focus of the experience (p.
30).
One might say that the cognitive self-awareness attendant on shame is more encompassing than with guilt. According to Lewis, shame involved more self-consciousness, self-imaging, and greater body awareness than guilt. Similarly, persons experiencing shame seem less able to cognitively sort out their actions from the more fundamental sense of self.
In addition to greater cognitive self-awareness, there were cognitive differences in qualities attributed to the self. Those experiencing shame tended to see themselves as worthless and powerless--unable to make changes in the environment or themselves. By contrast, those experiencing guilt saw themselves as able to take some sort of corrective action either toward the consequences of their behavior or toward future behavior (Tangney & Dearing, 2002; cf. Andrews, Qian, & Valentine, 2002; Efthim, Kenny, & Mahalik, 2001; Konstam et al., 2001).
Another aspect of the cognitive differences between shame and guilt concerned where the sense of evaluation seemed to originate. In shame, the source of blame or negative valuation of the self was localized as "out there," originating in the "other." This externalizing of blame was one of the chief markers of shame (Tangney & Dearing, 2002; Tangney et al., 1992, 1996). Even as an internal experience shame involved judgment of an internalized "disapproving other." With guilt, by contrast, the internal evaluation system was felt to originate more from within a person's own sense of self.
Affective Differences
There also are affective markers that distinguish shame and guilt. Using Lewis's (1971) theoretical distinctions Tangney (1990, 1995, 1996) has developed an instrument (the TOSCA--Test of Self-Conscious Affects) for measuring and distinguishing shame and guilt. Her work with this instrument has verified cognitive, affective, and motivational distinctions between the two emotions that can distinguish them. Following Lewis, Tangney concurred that the chief cognitive differ, race between shame and guilt was how the self was perceived, but she also pointed to affective differences between them.
Lack of empathy. One of Tangney's (1991; Tanguey & Dearing, 2002) central findings was that empathy was a key marker for differentiating shame from guilt. This finding derived from Lewis's (1971) point that shame involves a more global evaluation of the self than did guilt. True interpersonal guilt (feeling bad when one was aware of doing someone harm) hinged on (a) an empathic awareness of and response to someone's distress and (b) an awareness of being the cause of that distress. From this perspective, empathy was an essential prerequisite for guilt (Tangney; cf. Konstam et al., 2001; Leith & Baumeister, 1998). According to Tangney, it was the absence of empathy that was striking about the presence of shame. Tangney theorized that this might be because shame is such a painful and overwhelming experience that it naturally draws the focus away from the distressed other back to the self. Even when a shame-prone individual noticed and initially empathized with another, his or her empathic response might become short-circuited. "When faced with a distressed other, shame-prone individuals may be particularly likely to respond with a personal distress reaction, in lieu of a true empathic response" (Tangney, p. 600). This preoccupation with the self is'inconsistent with the other-oriented nature of empathy.
Anger and aggression. Another distinction is the link between shame, aggression, and anger that Tangney has demonstrated (Tangney, 1996; Tangney & Dearing, 2002; Tangney, Miller, Flicker, & Barlow, 1996; Tangney et al., 1992). This connection could take an active or passive form as the shamed individual attempted to manage his or her feelings. The more passive route was associated with anger turned inward (a ruminative, unexpressed anger), self-directed hostility, and a tendency to withdraw from anger-related situations. The more active route involved reactivating the impaired self through other-directed anger (e.g., by turning the tables and externalizing blame onto others involved in the shame-eliciting situation). For those who took a more active response, proneness to shame is associated with malevolent and fractious intentions and a likelihood of engaging in all manner of direct, indirect, and displaced aggression (Tangney & Dearing; Tangney et al., 1996).
By contrast, guilt-prone individuals were not disposed particularly to blame external factors or other people for negative events. Rather, when experiencing guilt they were likely to become aware of their role in negative interpersonal situations, and by extension felt an obligation to assess their impact on others. Thus, guilt produced a sense of tension and regret borne of empathy, which often led to reparative action such as confession, apology, or making amends (Tangney, 1996; Tangney & Dearing, 2002; cf. Konstam et al., 2001).
Motivational Differences
The movement toward reparative action provides a motivational marker for distinguishing shame and guilt. Shame involves a withdrawing from others--a shrinking or hiding, especially from shame-eliciting situations. Shame moves one away from others, perhaps through passive withdrawal or the externalization of blame. Guilt, on the other hand, moves one toward others in attempts to repair damage done, often through confession and restitution. Those experiencing guilt take responsibility for their actions and the consequences; the shame-prone person, unable to take responsibility, typically shifts the blame to another person (Tangney & Dearing, 2002; cf. Leith & Baumeister, 1998).
Thus, shame and guilt are experienced very differently, in terms of both thoughts and feelings as well as in behavioral motivations. As Tangney (1991) summarized it:
Because of its focus on specific and presumably controllable
behaviors, the guilt experience is uncomfortable but not
debilitating. That is, the self remains "able." Not surprisingly,
phenomenological reports indicate that guilt's consequent
motivation and behavior tends to be oriented toward reparative
action. Shame, on the other hand, is a much more global, painful,
and devastating experience in which the self, not just behavior, is
painfully scrutinized and negatively evaluated. This global
negative affect is often accompanied by a sense of shrinking and
being small, and by a sense of worthlessness and powerlessness.
Phenomenological data also suggest that shame is likely to be
accompanied by a desire to hide or to escape from the interpersonal
situation in question (p. 599).
Tangney and Dearing (2002) further concluded that guilt as the more adaptive of the two emotions was the more developmentally mature emotion to move people toward.
IMPLICATIONS OF THESE DISTINCTIONS FOR MENTAL HEALTH COUNSELING
Although shame and guilt often occur together, the distinctions described provide not only a means for determining whether shame or guilt is the dominant presenting emotion but also offer suggestive lines for the treatment of shame vs. guilt. These two emotions are not only significantly different in a client's experience, they also reflect differences in developmental and coping abilities. Being able to distinguish shame from guilt will help mental health counselors to offer interventions more appropriate to the experience of each emotion.
Criteria for Distinguishing Shame and Guilt
Since shame and guilt are easily confused because they often co-occur (Lewis, 1971; Nathanson, 1992; Tangney & Dearing, 2002), the first way the distinctions noted are helpful for the counselor is in providing criteria for determining whether a person is struggling more with shame or guilt. Since treatment for the two emotions differs (see below), there are several things to listen for or attend to in a client's presentation to help sort out which is dominant.
The "self' vs. the "thing done. "" From Lewis (1971), one would conclude that if the presentation of a problem is focused on a global sense of the person's badness rather than feeling bad about a specific action, then shame more than guilt is the central emotion. Conversely, guilt dominates when the concern is over the thing done rather than the self. This distinction is important diagnostically because a client who can judge his or her actions is at a different place developmentally from one who makes global condemnations of the self. The former has a clear, stable sense of self; the latter has a more tentative, diffuse sense of self.
This difference in the stability and cohesiveness of the self shows up in therapy in various ways. For instance, a guilt-laden depression would be evident in talk about actions taken or not taken, while a shame-laden depression would be characterized by reports of worthlessness or badness of the person (the self) rather than the deeds. Similarly, anxiety in a guilt-prone person would derive from an awareness of others and the harm done to them (e.g., the person is anxious about a mistake that has or will cause others to suffer). Anxiety connected to shame, however, would reflect a concern not with the other but with the self. Thus, the shame-prone person might be anxious because of a fear of being found out and judged (for a violation of standards and expectations either of one's own or others) or a fear of being asked to do things that would reveal one's deficiencies.
Boundary issues and compulsions. Erikson's (1950) placement of shame in a developmental conflict over autonomy suggests that the dominant emotion can be discerned through struggles over boundary issues and compulsions. For instance, clients who show no discretion in the choice of friends or indiscriminately let others take advantage of their good will are likely suffering from a deep sense of shame rather than guilt, which is connected to the less stable sense of self that is characteristic of a shame-dominated person. Because of the more diffuse boundaries to the self, the shame-prone person also might express a fear of intimacy as potentially engulfing. By contrast, the guilt-prone person with a clearer sense of self is not as fearful of the painful interaction with others that often accompanies having done wrong. The guilt-prone person has less fear of interaction because there is no concomitant fear that somehow the self will be overwhelmed or crushed in the exchange.
Boundary issues are discerned not only in concerns with their permeability but also through their rigidity and compulsivity. Learning boundaries (what is permitted or not; where self and other start and end), Erikson (1950) argued, develops the ego capacity of will. Compulsions would indicate deficiencies in ego capacity; the person feels less in control of thoughts or behaviors. Thus, a shame-dominated client will describe addictive behavior (e.g., gambling, alcohol, drugs) as simply his or her nature, something that cannot be controlled. Such a client, stuck in ruminations over how bad he or she is, would be paralyzed and unable to take reparative action. A guilt-dominated client is apt to describe these behaviors as bad choices, something for which he or she needs to make amends.
A different kind of compulsivity and rigidity can be seen in the perfectionist who compensates for a general lack of control by circumscribing a particular area for managing well. Such a person could be considered as struggling more with shame than with guilt. Similarly, the compulsive part of an obsessive-compulsive ritual is often a means of trying to regain control. Ironically, the absence of control over compulsive behavior often brings a greater sense of shame (cf. Carnes's [1983] description of the despair that follows acting out in an addiction cycle).
Although compulsive behavior occasionally can point to guilt (cf. Lady Macbeth's hand washing), Erikson (1950) would help the counselor appreciate compulsions as more a struggle over loss of control or will and thus more shame-based. Conversely, the client who struggles with guilt more than shame is more aware of what he or she can or cannot "do" (i.e., issues of initiative and sense of purpose).
Lack of empathy. Tangney's (1991) work elaborated how the diffuse global evaluation of one's badness that distinguished shame from guilt often manifested as a preoccupation with the self, with a concomitant inability to express empathy for others. Thus, a lack of empathy points to a dominance of shame over guilt (Tangney & Dearing, 2002).
Lack of empathy is connected to developmental deficits in the formation of the self (see above). By contrast, when guilt predominates, there is an ability to empathize and an appropriate concern for damage to the relationship or reparation of the other's loss. Thus, anxiety that derives from a client's ability to see the impact of his or her behavior on others is indicative of guilt. Shame-based anxiety might be characterized by a desire that others see how debilitating the anxiety is for the client and how in need of care the client is.
Blaming and anger. Tangney and Dearing (2002) also pointed to the distinguishing markers of externalizing blame and excessive anger (either internalized or projected outward) as markers that can alert the counselor to the potential dominance of shame. When in describing a problem a person focuses on the fault of another rather than his or her own role in the problem, shame may be more prevalent than guilt. Blaming others is a way of defending against the global, negative evaluation of the self (cf. Nathanson, 1992). Thus, a spouse who has trouble seeing his or her part in the creation of the marital tension or a client who thinks his or her anger is due to the actions of others is likely suffering from a deep sense of shame. The guilt-prone person is more accurately able to accept his or her role in relational problems.
However, the mental health counselor also must remember that some clients will turn the anger and blame inward. The client characterized by a global self-loathing may appear to acknowledge fault but then uses this acknowledgement as an excuse to avoid action. Having declared how bad one is, responsibility is shifted to the other. Where guilt is more dominant, each partner not only can hear the other's side more readily but is in a better place to take restorative steps.
Withdrawal. Both Erikson (1950) and Tangney (Tangney et al., 1996) have noted that a marker for the dominance of shame over guilt is withdrawal from others, which may take the active form of blaming others. Blaming, with its attendant anger, creates distance from others, thus achieving the goal of withdrawal. However, the counselor also must be aware that withdrawal may take a more passive route of isolation from others: Given the global, negative self-evaluation, a client may withdraw out of the conviction that others would not wish to associate with someone so blameworthy. Self-blame as an excuse for lack of action can be another way clients withdraw. By contrast, when guilt is the dominant emotion, the person is more likely to move toward others by making reparative gestures.
Treatment Differences
The characteristic distinctions between shame and guilt also point to important differences in treatment approach. Since shame and guilt often occur together, both will need a response but the proper response to each will differ. Developmental differences in the growth and stability of the self require treatments that take this trajectory into account. When dealing differentially with these two emotions, the focus, the goal, and the modality of the intervention will vary.
Focus of the intervention. When shame is the dominant emotion, the experiences rather than the actions of the self become the focus of interventions. Before someone overwhelmed with shame can properly evaluate the actions of the self, the person must come to grips with the more global negative evaluation of the self. Similarly, before the person overwhelmed by shame can have empathy for another's distress, the distress of the shame-filled person's sense of fundamental flaw must be addressed.
What this suggests in terms of treatment is an approach sensitive to the insight that developmentally shame precedes guilt. When issues of shame and the self lie behind a client's dysfunction, focusing on behavioral change to assuage guilt not only produces results that may be less than satisfactory but is apt to exacerbate feelings of shame. In fact, a counselor might discern when shame is the dominant emotion when a person engages (often repeatedly) in guilt remedies such as confession and forgiveness but finds no sense of relief.
For instance, those suffering from shame are sometimes counseled toward confession and forgiveness--appropriate responses to guilt, but premature or ineffective responses to shame. Forgiveness as an intervention for the guilt-prone is effective because there is a cohesive sense of self that can empathize (cf. McCullough, Worthington, & Rachal, 1997). For the shame-prone, thinking of forgiveness feels like a loss to the self, an invalidation of his or her wound. Even when the shame-prone person expresses a need to forgive, there is a self-focus to the motivation: For example, forgiving is a way to feel magnanimous or to be released from the added shame of not being a forgiving person.
Goals of the intervention. The developmental distinction between shame and guilt means the mental health counselor also must think developmentally about the goals of counseling. For instance, when shame is the dominant emotion, the goal becomes strengthening the self (e.g., helping the person learn to distinguish self from behaviors) as a necessary step to helping move the person toward ability to empathize with the other. Since shame short-circuits empathic response, because the person is too preoccupied with judging his or her flawed nature to attend to the feelings of others, counseling needs to focus first on creating a safe, nonjudgmental context in which a self overwhelmed with shame can relax the defenses that belong to such self-judgment. Far from encouraging the self-absorption that accompanies shame, this aspect of counseling becomes a necessary step in nurturing the ego capacity that makes the next developmental step successful (cf. Erikson, 1950).
Counseling that is sensitive to the developmental relation between shame and guilt will see growth emerging in separate steps. Although the penultimate goal of counseling with those experiencing shame will be to strengthen the self overcome by its sense of being flawed, the ultimate goal with such a client would be to strengthen the self so that it might move toward guilt--that is, toward a response in which the self can see itself as acting badly, see the consequences of its actions, take responsibility for its actions, and move toward reparation in relationships rather than being stuck in self-loathing about feeling essentially and fundamentally flawed (Tangney & Dearing, 2002). Such self-preoccupation actually keeps one distant from others and unable to attend to how one's action affects the other.
Modality of the intervention. Not only must the focus and goal of the intervention be different for shame vs. guilt, its modality must be adapted as well. Since developmentally shame precedes guilt, it involves a different level of ego functioning. Conceptually shame might need more supportive or relationally oriented counseling; guilt would respond to more traditional insight or behavioral change counseling approaches. Behavioral interventions focused on things done, which might work well with guilt, need to give way to relationship building when shame dominates and the self needs strengthening. This is not to say that behavioral treatment will have no impact on shame issues, but it does argue that a shame-based person requires a qualitatively different kind of relational encounter than a guilt-based person. A shame-based person seems to need to experience affirmation and acceptance in the interchange with another, while a more cognitive verification or acknowledgement of the other's forgiveness seems to facilitate release of guilt. There is a subtle yet vital difference in these interactions. In actual practice, of course, for a number of reasons counselors find themselves moving back and forth between supportive and insight-oriented comments, but in this context it may be seen as an aspect of the fact that clients often bring guilt overlaid with shame to counseling (Tangney & Dearing, 2002).
When shame is more dominant than guilt, the client might be expected to be motivated to conceal issues due to fear of a negative evaluation from the counselor that would mirror the client's negative self-evaluation and heightened sensitivity to the thoughts of a projected disapproving other (Tangney & Dearing, 2002). Such negative expectations can impact the quality of the therapeutic relationship (i.e., "transference") and the client's ability to benefit (Gilbert, Pehl, & Allan, 1994). Attending to the quality of the relationship (e.g., negative transference) can open up opportunities for acknowledgement and exploration of shame. Mental health counselors can help those experiencing shame to move toward understanding what these experiences can teach about self and relationships by providing a safe, nonretaliating alternative to self-condemnation and the anticipated judgment from the counselor as disapproving other. This new kind of relationship can provide a foundation for and example of further development of empathy and guilt.
CONCLUSION
Recent literature, both theoretical and empirical, has verified that shame is an emotion distinct from guilt. However, a significant trend in clinical work has been to subsume shame under guilt, to treat it as secondary, or not to recognize it as an important, even key, emotion in its own right. Even though shame is a prominent emotion in our culture, current treatments often focus on modalities that are premature, ineffective, and sometimes harmful to those whose issues revolve around shame rather than guilt. We have argued for the need to recognize the psychological differences between shame and guilt so as to better distinguish and treat those suffering with these emotions. Although both often appear together in clients (to greater or lesser degrees), being able to distinguish between them has both heuristic and practical clinical value.
REFERENCES
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Capps, D. (1993). The depleted self: Sin in a narcissistic age. Minneapolis, MN: Fortress Press.
Carnes, P. (1983). Out of the shadows. Minneapolis, MN: CompCare Publishers.
Cheng, H., & Page, R. (1995). A comparison of Chinese (in Taiwan) and American perspectives of love, guilt, and anger. Journal of Mental Health Counseling, 17, 210-219.
Efthim, P., Kenny, M., & Mahalik, J. (2001). Gender role stress in relation to shame, guilt and externalization. Journal of Counseling and Development, 79, 430-438.
Erikson, E. (1950). Childhood and society. New York: W.W. Norton & Company.
Fowler, J. (1996). Faithful change: The personal and public challenges of postmodern life. Nashville, TN: Abingdon Press.
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Kaufman, G. (2004). The psychology of shame: Theory and treatment of shame-based syndromes (3rd ed.) New York: Springer Publishing Company, Inc.
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Lansky, M. (1995). Shame and the scope of psychoanalytic understanding. American Behavioral Scientist, 38, 1076-1090.
Leith, K., & Baumeister, R. (1998). Empathy, shame, guilt, and narratives of interpersonal conflict: Guilt-prone people are better at perspective taking. Journal of Personality, 66, 1-37.
Lewis, H. (1971). Shame and guilt in neurosis. New York: International Universities Press.
McCullough, M., Worthington, E., & Rachal, K.(1997). Interpersonal forgiving in close relationships. Journal of Personality and Social Psychology, 73, 321-336.
Nathanson, D. (1992). Shame and pride: Affect, sex, and the birth of the self. New York: W.W. Norton & Company.
Scheff, T. (1995). Shame and related emotions: An overview. American Behavioral Scientist, 38, 1053 1059.
Tangney, J. (1990). Assessing individual differences in proneness to shame and guilt: Development of the self-conscious affect and attribution inventory. Journal of Personality and Social Psychology, 59, 102-111.
Tangney, J. (1991). Moral affect: The good, the bad, and the ugly. Journal of Personality and Social Psychology, 61, 598~507.
Tangney, J. (1995). Recent advances in the empirical study of shame and guilt. American Behavioral Scientist, 38, 1132-1145.
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Tangney, J., & Dearing, R. (2002). Shame and guilt. New York: Guilford Publications.
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Stephen Parker is affiliated with Regent University. Rebecca Thomas is in private practice in Norfolk, Virginia. Correspondence concerning this article should be addressed to Stephen Parker, 1000 Regent University Drive, Virginia Beach, VA 23464. E-mail: steppar@regent.edu.
Monday, May 3, 2010
My Book
My book has now been published through Cedar Fort Inc. Go to cedarfort.com to pre-order a copy. It will be released on Saturday. Here is a brief description:
Modern life often stabs at our happiness. Love and harmony are not always easy to achieve, especially when so many things are eager to take their place. How does one distinguish hidden dangers, false idols, and destructive habits from fulfilling relationships and true happiness? Seasoned clinical psychotherapist Jade Mangus analyzes different types of dysfunction and alienation and explains how certain patterns become problematic and destructive. Mangus guides the reader through the emotional reefs of overcoming dread, shame, pain, and fear to achieve and reclaim a healthy relationship with self, others, and God. With helpful tools and a no-nonsense approach, this book is sure to open doors to healing emotionally.
Wednesday, April 28, 2010
Conditioning and Addiction
Through my research for my upcoming book, I found a substantial amount of article which discussed the conditioning factors behind addictive behavior. I feel the reason for the amount could be the fact that the idea of conditioning is almost as old as the study of psychology.
This theory is based in the ideas and research of Ivan Pavlov and his hungry salivating dogs (which most of us may remember from high school psychology class). Pavlov discovered and documented the principles governing how animals, and then adapted to humans, learn. Two basic kinds of learning or conditioning occur: operant and classical.
Classical conditioning, was the initial type of association first discovered by Pavlov as he noticed a relationship between a bell and the salivation of his dogs. Specifically, the animal learns to associate a neutral stimulus (like the ringing of a bell) with a stimulus that has great, even survival meaning based on how closely in time the two stimuli are presented. Dogs are able to learn the association between bell and food, (as humans are between two yellow arches and high calorie hamburgers) and will salivate immediately after hearing the bell once this connection has been made.
Marketers are well aware of classical conditioning. Next time you watch commercials on television, think to yourself, “What is the hidden message in this commercial?” For example, I once saw a beer commercial where a man began to drink the competitor's beer and women around him ran away, next to him was a man who began to drink the advertised beer, and those same women ran up to him and began to take off his shirt—what message is being sent? Sex definitely sells, especially beer!
Operant, also know as instrumental conditioning is a little more obvious than classical. In operant conditioning an animal or human learns to perform particular behaviors in order to obtain an intrinsically rewarding stimulus. For example, why do many people work jobs that they don't enjoy—to get a paycheck.
Many therapist have used the Classical, or Pavlovian conditioning theory to understand the nature of addictions. Truly, there are many obvious examples which would support the classical conditioning aspects of developing a dependence, especially on drugs. The inebriating or “drunk” effects of people given non-alcoholic drinks (such as “near beer”), when the individuals were told they were getting alcoholic drinks can be evidence for this type of conditioning. As with the individual addicted to cocaine, who begins to sweat at the sight of sugar or flour. I have noticed a strong association between “good times” and food. Just think of any typical Christmas party, what comes to mind? If you thought chocolate treats in the shape of Santa Claus, you have experienced the affects of conditioning.
Situational cues and conditioning have an important role in our understanding of addiction. As previously eluded to, there is evidence that many behaviors such as alcohol and drugs can be produced by placebo doses and have to same effects on the person taking them.
Even after long periods of abstinence, a person could still struggle with the affects of addiction conditioning. For example, I once had a client, who after 40 years of sobriety came in to see me because he “scared himself”. He reported how on a previous day, he was driving past an old bar he used to drink at, “without thinking” he found himself parking his car and approaching the door of the tavern. He stated, “It was like I was in a zombie mode... I couldn't think straight!” As he walked through the door, the smell of alcohol reached his senses “I don't remember ever wanting a beer so much in my life!” Fortunately, his wife call his phone and asked, “Where are you?” This was enough “reboot [his] brain”, and he said to her “Wow, I am in a bar”. She calmly replied, “Well, you better get out of there.” Again, he was shocked that this old association was still so very strong. This is the power of conditioning.
This theory is based in the ideas and research of Ivan Pavlov and his hungry salivating dogs (which most of us may remember from high school psychology class). Pavlov discovered and documented the principles governing how animals, and then adapted to humans, learn. Two basic kinds of learning or conditioning occur: operant and classical.
Classical conditioning, was the initial type of association first discovered by Pavlov as he noticed a relationship between a bell and the salivation of his dogs. Specifically, the animal learns to associate a neutral stimulus (like the ringing of a bell) with a stimulus that has great, even survival meaning based on how closely in time the two stimuli are presented. Dogs are able to learn the association between bell and food, (as humans are between two yellow arches and high calorie hamburgers) and will salivate immediately after hearing the bell once this connection has been made.
Marketers are well aware of classical conditioning. Next time you watch commercials on television, think to yourself, “What is the hidden message in this commercial?” For example, I once saw a beer commercial where a man began to drink the competitor's beer and women around him ran away, next to him was a man who began to drink the advertised beer, and those same women ran up to him and began to take off his shirt—what message is being sent? Sex definitely sells, especially beer!
Operant, also know as instrumental conditioning is a little more obvious than classical. In operant conditioning an animal or human learns to perform particular behaviors in order to obtain an intrinsically rewarding stimulus. For example, why do many people work jobs that they don't enjoy—to get a paycheck.
Many therapist have used the Classical, or Pavlovian conditioning theory to understand the nature of addictions. Truly, there are many obvious examples which would support the classical conditioning aspects of developing a dependence, especially on drugs. The inebriating or “drunk” effects of people given non-alcoholic drinks (such as “near beer”), when the individuals were told they were getting alcoholic drinks can be evidence for this type of conditioning. As with the individual addicted to cocaine, who begins to sweat at the sight of sugar or flour. I have noticed a strong association between “good times” and food. Just think of any typical Christmas party, what comes to mind? If you thought chocolate treats in the shape of Santa Claus, you have experienced the affects of conditioning.
Situational cues and conditioning have an important role in our understanding of addiction. As previously eluded to, there is evidence that many behaviors such as alcohol and drugs can be produced by placebo doses and have to same effects on the person taking them.
Even after long periods of abstinence, a person could still struggle with the affects of addiction conditioning. For example, I once had a client, who after 40 years of sobriety came in to see me because he “scared himself”. He reported how on a previous day, he was driving past an old bar he used to drink at, “without thinking” he found himself parking his car and approaching the door of the tavern. He stated, “It was like I was in a zombie mode... I couldn't think straight!” As he walked through the door, the smell of alcohol reached his senses “I don't remember ever wanting a beer so much in my life!” Fortunately, his wife call his phone and asked, “Where are you?” This was enough “reboot [his] brain”, and he said to her “Wow, I am in a bar”. She calmly replied, “Well, you better get out of there.” Again, he was shocked that this old association was still so very strong. This is the power of conditioning.
Saturday, April 17, 2010
Avoidant Personality Disorder: A Defense Against the Social Anxiety Attacks
I have been meeting with a lot of clients who either have an avoidant personality disorder, or live with someone who does - since the majority of people with this type of personality will not meet with a therapist, I thought I would blog on it and give some insights into this issue.
In Avoidant Personality Disorder, the person maintains a systematic avoidance of social contacts and any situation which might result in embarrassment or anxiety. Even with people who are close, he or she avoids a more intimate involvement.
The permanent expectations of being ridiculed, criticized, rejected puts the person constantly at the borderline of suffering anxiety attacks. Then he develops a permanent scheme of self-protection against anxiety.
Some signs and symptoms are found in these people. Sometimes the symptoms predominate and the disorder goes unnoticed by the majority of people with whom the bearer has contact (because symptoms are subjectives).
– They tend to live alone
– Contact with family and friends can be enjoyable, but only for a short period of time (minute or hours) and anxiety can be aroused at any moment.
– They avoid contact with strangers. They are extremely kind when such contact occurs and they do everything possible to make sure that such contact is brief.
– They develop at least one phobia (for animals or objects) whose origin is connected with the earlier appearance of anxiety attacks in social situations. The animal or object connected with such situations unleashes the anxiety and this assumes phobic characteristics.
– They are aware that they have abdicated certain experiences in life in order to avoid suffering.
– They often fantasize about the situations they avoid and yet would like to experience – in their fantasies they exclude the anxiety-provoking stimuli.
– They can be professionally successful, but they could be even more successful if they did not turn their backs on opportunities.
What is the difference between Avoidant Personality Disorder, Shyness, Social Anxiety, Generalized Social Phobia and Introverted Personality?
Shyness – As I see it, the difference is that in Shyness the person still tries to face situations which generate fear, even if only to show others what she is capable of getting. The situation may be uncomfortable yet the person tries to convey the message to those around him that he is liking or enjoying it. The desire to integrate oneself is so intense that the anxiety takes a back seat. Above all, the person has to show that she can get the same things other people can and enjoy them as much as they do.
Social Anxiety – In Social Anxiety, the person avoids social contacts and performance, mainly those that unleash extreme anxiety like panic attacks, but he wants to have such contacts and preserves the potentialities of affective involvement and feels comfortable with people who are close.
Generalized Social Phobia – In Generalized Social Phobia, a.k.a. Generalized Social Anxiety, the person suffers anxiety attacks due to exposure to many social situations. There is avoidance, to protect oneself, but the person wants to live like the others and have the same opportunities.
Avoidant Personality Disorder – In Avoidant Personality Disorder, besides the behaviors and attitudes described, we can see that the person has given up altogether on facing situations that generate fear and does not undergo anxiety attacks simply because she avoids any anxiety-generating situation that is possible. Additionally, she does everything possible not to be noticed.
Introverted Personality - Avoidance Personality Disorder has external similarities to the Introverted Personality. Nevertheless, within people there are differences. The main one is that the person with introverted personality does not feel anxiety when it is necessary to maintain social contact.
In my clinical observation, Avoidant Personality Disorder is preceded by anxiety attacks and even some panic attacks, which become occasional attacks or even stop due to the avoidance mechanisms that are developed.
Source:
www.social-anxiety-shyness-info.com
In Avoidant Personality Disorder, the person maintains a systematic avoidance of social contacts and any situation which might result in embarrassment or anxiety. Even with people who are close, he or she avoids a more intimate involvement.
The permanent expectations of being ridiculed, criticized, rejected puts the person constantly at the borderline of suffering anxiety attacks. Then he develops a permanent scheme of self-protection against anxiety.
Some signs and symptoms are found in these people. Sometimes the symptoms predominate and the disorder goes unnoticed by the majority of people with whom the bearer has contact (because symptoms are subjectives).
– They tend to live alone
– Contact with family and friends can be enjoyable, but only for a short period of time (minute or hours) and anxiety can be aroused at any moment.
– They avoid contact with strangers. They are extremely kind when such contact occurs and they do everything possible to make sure that such contact is brief.
– They develop at least one phobia (for animals or objects) whose origin is connected with the earlier appearance of anxiety attacks in social situations. The animal or object connected with such situations unleashes the anxiety and this assumes phobic characteristics.
– They are aware that they have abdicated certain experiences in life in order to avoid suffering.
– They often fantasize about the situations they avoid and yet would like to experience – in their fantasies they exclude the anxiety-provoking stimuli.
– They can be professionally successful, but they could be even more successful if they did not turn their backs on opportunities.
What is the difference between Avoidant Personality Disorder, Shyness, Social Anxiety, Generalized Social Phobia and Introverted Personality?
Shyness – As I see it, the difference is that in Shyness the person still tries to face situations which generate fear, even if only to show others what she is capable of getting. The situation may be uncomfortable yet the person tries to convey the message to those around him that he is liking or enjoying it. The desire to integrate oneself is so intense that the anxiety takes a back seat. Above all, the person has to show that she can get the same things other people can and enjoy them as much as they do.
Social Anxiety – In Social Anxiety, the person avoids social contacts and performance, mainly those that unleash extreme anxiety like panic attacks, but he wants to have such contacts and preserves the potentialities of affective involvement and feels comfortable with people who are close.
Generalized Social Phobia – In Generalized Social Phobia, a.k.a. Generalized Social Anxiety, the person suffers anxiety attacks due to exposure to many social situations. There is avoidance, to protect oneself, but the person wants to live like the others and have the same opportunities.
Avoidant Personality Disorder – In Avoidant Personality Disorder, besides the behaviors and attitudes described, we can see that the person has given up altogether on facing situations that generate fear and does not undergo anxiety attacks simply because she avoids any anxiety-generating situation that is possible. Additionally, she does everything possible not to be noticed.
Introverted Personality - Avoidance Personality Disorder has external similarities to the Introverted Personality. Nevertheless, within people there are differences. The main one is that the person with introverted personality does not feel anxiety when it is necessary to maintain social contact.
In my clinical observation, Avoidant Personality Disorder is preceded by anxiety attacks and even some panic attacks, which become occasional attacks or even stop due to the avoidance mechanisms that are developed.
Source:
www.social-anxiety-shyness-info.com
Friday, April 9, 2010
Asperger's Relationship
Are Asperger relationships difficult to maintain? The social skill and communication issues inherent in Asperger's syndrome can challenge some relationships. However, there are ways for both the person with Aspergers and loved ones to successfully work through the issues. A person with Aspergers can form meaningful and close relationships with parents, spouses, extended family and friends.
Common Asperger Relationship Issues
A person with Aspergers and his loved ones may find themselves in conflicts that have root in key aspects of the condition. The conflicts are often misunderstandings that stem from differences in emotional responses, communication and social skills problems, routines and obsessive behaviors. The person without Aspergers or neurotypical and the person with Aspergers may have different sets of expectations and ways of relating in a relationship. Learning about Asperger characteristics can help family members and friends better understand their loved one.
Emotional Response
A person with Aspergers has problems understanding another person's emotions. He may not be able to properly interpret facial expressions, body language or gestures. The inability to interpret others emotions is often referred to as mindblindness. This may lead a neurotypical person to misunderstand his reactions to an emotional situation and view a response as inappropriate or negative.
Sometimes a neurotypical person may mistakenly interpret a person with Aspergers' emotional response or lack of response as an inability to feel emotion. This is not true. A person with Aspergers feels emotion but he may have trouble expressing his emotion or find unusual ways to express it.
Communication and Social Skills Problems
Asperger's syndrome causes problems with language, communication and social interaction. A person with Aspergers may not be able to make friends easily and may also find two-way conversation difficult. He may appear to talk at people, rather than with them and fixate on favorite topics even if the other party shows distinct signs of disinterest or distress. He continues to talk about the topic and is oblivious to the other party's reaction. He also may misunderstand language at time and taking many things literally, missing subtlety.
In a relationship, the communication problems can easily lead to misunderstandings. In relationships, the neurotypical person often takes on the role of helping the person with Aspergers and others understand each other better in social situations. Some romantic relationships also become strained because the neurotypical person gets frustrated with being the couple's main social connection to the rest of the world.
Routines and Obsessive Behaviors
Routines and obsessive behaviors are aspects of Aspergers that can also challenge relationships. A person with Aspergers may get extremely upset over interruptions in daily routines or any attempt to redirect him away from an obsessive behavior. The neurotypical person may see the negative reaction to the interruption as irrational. However, the person with Aspergers may see the interruption as a personal insult or an attempt to take away something essential to daily functioning.
Asperger's syndrome may involve obsessive behaviors or sensory issues that some neurotypical people find disturbing. Examples of obsessive behavior include a fixation on an activity like memorizing sports trivia and talking about it for hours or ritualistic hand washing.
It is important for a loved one show some sensitivity in her reaction to the routines and obsessive behavior.
How to Help Relationships Thrive
The most important way to help a relationship thrive is to never give up hope. Learn about Asperger's syndrome through research and talking with therapists. Since each case of Aspergers is unique, pay attention to a loved one's specific concerns and personality. Figure out what is important to him and try to respect necessary boundaries. Find common ground whenever possible and cherish it. Consider participating in family or couple's therapy for Aspergers and autism. Experts can help families find better ways to relate to each other.
Resources For Family Members and Couples
A number of Asperger and autism support organizations have information on local support groups for people with Aspergers and their families and friends. The following websites provide helpful information on relationships:
* FAAAS: Families of Adults Affected by Asperger's Syndrome (FAAAS)has forums, articles and resources for spouses and other family of people with Aspergers.
* IAN Community: The Interactive Autism Network (IAN) site provides articles and a discussion forum with information provided from people with autism spectrum disorder, families and autism experts. The site has a interesting article on a couple dealing with Aspergers.
* ASPEN: Asperger Syndrome Education Support Network (ASPEN) has helpful resources for families and friends of people with Aspergers.
* OASIS: Online Asperger Syndrome Information and Support (OASIS) has detailed articles and support group information.
Hope for Relationships
A person with Aspergers can have healthy and happy relationships with a spouse, parents, extended family and friends. For relationship success, everyone needs to work together. The neurotypical person should gain a strong understanding of both the Aspergers condition and the person involved. The person with Aspergers should be willing to participate on some level. There is always hope when people love each other and have a determination to try to make a relationship succeed.
Sources:
McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010 (inactive 2008-06-25). PMID 17030291.
Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". in Frith U. Autism and Asperger syndrome. Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.
Adrienne Warber (2009) "aspergers in relationships" Needtoknow.com
Common Asperger Relationship Issues
A person with Aspergers and his loved ones may find themselves in conflicts that have root in key aspects of the condition. The conflicts are often misunderstandings that stem from differences in emotional responses, communication and social skills problems, routines and obsessive behaviors. The person without Aspergers or neurotypical and the person with Aspergers may have different sets of expectations and ways of relating in a relationship. Learning about Asperger characteristics can help family members and friends better understand their loved one.
Emotional Response
A person with Aspergers has problems understanding another person's emotions. He may not be able to properly interpret facial expressions, body language or gestures. The inability to interpret others emotions is often referred to as mindblindness. This may lead a neurotypical person to misunderstand his reactions to an emotional situation and view a response as inappropriate or negative.
Sometimes a neurotypical person may mistakenly interpret a person with Aspergers' emotional response or lack of response as an inability to feel emotion. This is not true. A person with Aspergers feels emotion but he may have trouble expressing his emotion or find unusual ways to express it.
Communication and Social Skills Problems
Asperger's syndrome causes problems with language, communication and social interaction. A person with Aspergers may not be able to make friends easily and may also find two-way conversation difficult. He may appear to talk at people, rather than with them and fixate on favorite topics even if the other party shows distinct signs of disinterest or distress. He continues to talk about the topic and is oblivious to the other party's reaction. He also may misunderstand language at time and taking many things literally, missing subtlety.
In a relationship, the communication problems can easily lead to misunderstandings. In relationships, the neurotypical person often takes on the role of helping the person with Aspergers and others understand each other better in social situations. Some romantic relationships also become strained because the neurotypical person gets frustrated with being the couple's main social connection to the rest of the world.
Routines and Obsessive Behaviors
Routines and obsessive behaviors are aspects of Aspergers that can also challenge relationships. A person with Aspergers may get extremely upset over interruptions in daily routines or any attempt to redirect him away from an obsessive behavior. The neurotypical person may see the negative reaction to the interruption as irrational. However, the person with Aspergers may see the interruption as a personal insult or an attempt to take away something essential to daily functioning.
Asperger's syndrome may involve obsessive behaviors or sensory issues that some neurotypical people find disturbing. Examples of obsessive behavior include a fixation on an activity like memorizing sports trivia and talking about it for hours or ritualistic hand washing.
It is important for a loved one show some sensitivity in her reaction to the routines and obsessive behavior.
How to Help Relationships Thrive
The most important way to help a relationship thrive is to never give up hope. Learn about Asperger's syndrome through research and talking with therapists. Since each case of Aspergers is unique, pay attention to a loved one's specific concerns and personality. Figure out what is important to him and try to respect necessary boundaries. Find common ground whenever possible and cherish it. Consider participating in family or couple's therapy for Aspergers and autism. Experts can help families find better ways to relate to each other.
Resources For Family Members and Couples
A number of Asperger and autism support organizations have information on local support groups for people with Aspergers and their families and friends. The following websites provide helpful information on relationships:
* FAAAS: Families of Adults Affected by Asperger's Syndrome (FAAAS)has forums, articles and resources for spouses and other family of people with Aspergers.
* IAN Community: The Interactive Autism Network (IAN) site provides articles and a discussion forum with information provided from people with autism spectrum disorder, families and autism experts. The site has a interesting article on a couple dealing with Aspergers.
* ASPEN: Asperger Syndrome Education Support Network (ASPEN) has helpful resources for families and friends of people with Aspergers.
* OASIS: Online Asperger Syndrome Information and Support (OASIS) has detailed articles and support group information.
Hope for Relationships
A person with Aspergers can have healthy and happy relationships with a spouse, parents, extended family and friends. For relationship success, everyone needs to work together. The neurotypical person should gain a strong understanding of both the Aspergers condition and the person involved. The person with Aspergers should be willing to participate on some level. There is always hope when people love each other and have a determination to try to make a relationship succeed.
Sources:
McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010 (inactive 2008-06-25). PMID 17030291.
Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". in Frith U. Autism and Asperger syndrome. Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.
Adrienne Warber (2009) "aspergers in relationships" Needtoknow.com
Thursday, April 8, 2010
Emotional Avoidance and Traumatic Stress
PTSD and emotional avoidance go hand-in-hand. Many people with PTSD try to get away from or avoid their emotions. Emotional avoidance is part of the avoidance cluster of PTSD symptoms.
Avoidance symptoms make up one cluster of PTSD symptoms. Specifically, the avoidance cluster of PTSD symptoms include:
* Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
* Making an effort to avoid places or people that remind you of the traumatic event.
* Having a difficult time remembering important parts of the traumatic event.
* A loss of interest in important, once positive, activities.
* Feeling distant from others.
* Experiencing difficulties having positive feelings such as happiness or love.
* Feeling as though your life may be cut short.
The first symptom includes the avoidance of emotional experience, which is common among people with PTSD.
Emotional Avoidance in PTSD
It has been found that people with PTSD often try to avoid or “push away” their emotions, both emotions about a traumatic experience and emotions in general. Studies have found that people with PTSD may withhold expressing emotions. In addition, it has been found that the avoidance of emotions may make some PTSD symptoms worse or even contribute to the development of PTSD symptoms after the experience of a traumatic event.
Why Emotional Avoidance Does Not Work
It is important to recognize that we have emotions for a reason. Our emotions provide us with information about ourselves and the things going on around us. For example, the emotion of fear tells us that we may be in danger. The emotion of sadness tells us that we may need some time to take care of ourselves or seek out help from others. Given the important role they play in our lives, our emotions are there to be experienced and they want to be experienced.
Therefore, while emotional avoidance may be effective in the short-run and may provide you with some temporary relief, in the long run, the emotions you're trying to avoid may grow stronger. Basically, your emotions may “fight back” so they can be be experienced and listened to. If someone is determined to avoid his emotions, he may then turn to more drastic and unhealthy ways of avoiding emotions, such as through substance use.
Avoiding our emotions also takes considerable effort, especially when those emotions are strong (as they often are in PTSD). As avoided emotions grow stronger, more and more effort is needed to keep them at bay. As a result, little energy may be left for the important things in your life, such as family and friends. In addition, using all your energy to avoid certain emotions may make it difficult to manage other experiences, such as frustration and irritation, making you more likely to be “on edge” and angry.
What Can Be Done
The most important thing to do is to reduce the extent that you try to escape your emotions. Of course, this is a lot easier said than done. If you have been avoiding your emotions for a long time, it may be difficult to release them. Sometimes, when we let our emotions build up, they may escape all at once, like a dam breaking. This may lead to our emotions feeling out of control.
It is important to find ways to release your emotions. Therapy of all kinds can be very helpful in this regard. Cognitive-behavioral and psychoanalytic/psychodynamic therapies all give you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. In addition to examining emotions connected directly to the traumatic event, cognitive-behavioral approaches may address how certain thoughts or ways of evaluating a situation may be contributing to your emotions. Acceptance and Commitment Therapy (or ACT), a particular type of behavior therapy, focuses on breaking down avoidance and helping a person place his energy into living a meaningful life (and being willing to experience whatever emotions arise as a result). Psychoanalytic/psychodynamic approaches may pay more attention to early childhood experiences and their influence on your emotions. Either way, therapy can provide you with a safe place to express and approach your emotions. Seeking social support from trusted loved ones can also provide a safe way to express your emotions. Finally, writing about your feelings can also give you a safe and private way to release your deepest feelings.
If your emotions feel really unclear or unpredictable, self-monitoring may be a useful strategy for you. It can give you a sense of what situations bring of certain thoughts and feelings. Finally, if your emotions feel too strong, try distraction instead of avoidance. Distraction can be viewed as “temporary avoidance.” Do something to temporarily distract you from a strong emotion, such as reading a book, calling a friend, eating comforting food, or taking a bath. This may give the emotion some time to decrease in strength, making it easier to cope with.
Sources:
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. Hayes, S. C., Strosahl, K.D., Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Roemer, L., Litz, B. T., Orsillo, S. M. & Wagner, A. (2001). A preliminary investigation of the role of strategic withholding of emotion in PTSD. Journal of Traumatic Stress, 14, 149-156.
Salters-Pedneault, K., Tull, M.T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders.
Applied and Preventive Psychology, 11, 95-114.
Tull, M.T., Gratz, K.L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754-761.
Avoidance symptoms make up one cluster of PTSD symptoms. Specifically, the avoidance cluster of PTSD symptoms include:
* Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
* Making an effort to avoid places or people that remind you of the traumatic event.
* Having a difficult time remembering important parts of the traumatic event.
* A loss of interest in important, once positive, activities.
* Feeling distant from others.
* Experiencing difficulties having positive feelings such as happiness or love.
* Feeling as though your life may be cut short.
The first symptom includes the avoidance of emotional experience, which is common among people with PTSD.
Emotional Avoidance in PTSD
It has been found that people with PTSD often try to avoid or “push away” their emotions, both emotions about a traumatic experience and emotions in general. Studies have found that people with PTSD may withhold expressing emotions. In addition, it has been found that the avoidance of emotions may make some PTSD symptoms worse or even contribute to the development of PTSD symptoms after the experience of a traumatic event.
Why Emotional Avoidance Does Not Work
It is important to recognize that we have emotions for a reason. Our emotions provide us with information about ourselves and the things going on around us. For example, the emotion of fear tells us that we may be in danger. The emotion of sadness tells us that we may need some time to take care of ourselves or seek out help from others. Given the important role they play in our lives, our emotions are there to be experienced and they want to be experienced.
Therefore, while emotional avoidance may be effective in the short-run and may provide you with some temporary relief, in the long run, the emotions you're trying to avoid may grow stronger. Basically, your emotions may “fight back” so they can be be experienced and listened to. If someone is determined to avoid his emotions, he may then turn to more drastic and unhealthy ways of avoiding emotions, such as through substance use.
Avoiding our emotions also takes considerable effort, especially when those emotions are strong (as they often are in PTSD). As avoided emotions grow stronger, more and more effort is needed to keep them at bay. As a result, little energy may be left for the important things in your life, such as family and friends. In addition, using all your energy to avoid certain emotions may make it difficult to manage other experiences, such as frustration and irritation, making you more likely to be “on edge” and angry.
What Can Be Done
The most important thing to do is to reduce the extent that you try to escape your emotions. Of course, this is a lot easier said than done. If you have been avoiding your emotions for a long time, it may be difficult to release them. Sometimes, when we let our emotions build up, they may escape all at once, like a dam breaking. This may lead to our emotions feeling out of control.
It is important to find ways to release your emotions. Therapy of all kinds can be very helpful in this regard. Cognitive-behavioral and psychoanalytic/psychodynamic therapies all give you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. In addition to examining emotions connected directly to the traumatic event, cognitive-behavioral approaches may address how certain thoughts or ways of evaluating a situation may be contributing to your emotions. Acceptance and Commitment Therapy (or ACT), a particular type of behavior therapy, focuses on breaking down avoidance and helping a person place his energy into living a meaningful life (and being willing to experience whatever emotions arise as a result). Psychoanalytic/psychodynamic approaches may pay more attention to early childhood experiences and their influence on your emotions. Either way, therapy can provide you with a safe place to express and approach your emotions. Seeking social support from trusted loved ones can also provide a safe way to express your emotions. Finally, writing about your feelings can also give you a safe and private way to release your deepest feelings.
If your emotions feel really unclear or unpredictable, self-monitoring may be a useful strategy for you. It can give you a sense of what situations bring of certain thoughts and feelings. Finally, if your emotions feel too strong, try distraction instead of avoidance. Distraction can be viewed as “temporary avoidance.” Do something to temporarily distract you from a strong emotion, such as reading a book, calling a friend, eating comforting food, or taking a bath. This may give the emotion some time to decrease in strength, making it easier to cope with.
Sources:
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. Hayes, S. C., Strosahl, K.D., Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Roemer, L., Litz, B. T., Orsillo, S. M. & Wagner, A. (2001). A preliminary investigation of the role of strategic withholding of emotion in PTSD. Journal of Traumatic Stress, 14, 149-156.
Salters-Pedneault, K., Tull, M.T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders.
Applied and Preventive Psychology, 11, 95-114.
Tull, M.T., Gratz, K.L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754-761.
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