A recent article by Dr Sandy Miles highlighted the fact that, in the case of trainee doctors, shame is a highly prevalent, though rarely discussed, emotion that is experienced by many of them.  Unacknowledged, it can easily become something that damages their relationships both with their colleagues and their patients and, just as importantly, with themselves.

In reading that paper I found myself seeing many parallels with some of the intractable difficulties in relationships that I encounter as a couple therapist and the unaddressed emotions of shame that often lie deep within them.

Brene Brown in her book Daring Greatly, describes how shame causes one or more of these responses

  • Moving Away (physically withdrawing, silencing the self, keeping secrets)
  • Moving Toward (seeking to appease and please others)
  • Moving Against (seeking to gain power by aggression or shaming others).

For instance, there is the couple who are locked into a pattern where one partner sees the other as the sole cause of all the problems in their relationship.  Shifting people away from that perception is often, in my experience, very difficult and it is often blocked by unacknowledged feelings of shame on both sides.  The ‘assertive partner’ can often be quite fragile themselves, fearing the shame that any recognition that they are contributing something to their difficulties will overwhelm them.  Likewise the ‘submissive’ one, who probably feels at some level quite angry that they are being labeled in this way, is nevertheless held back by a fear of the shame that they might feel if they were to assert themselves.  

Brene Brown explains that shame is an integral part of the human experience.  In fact there can be positive benefits of shame in maintaining a moral compass and taking responsibility for one’s actions. The healthy position to seek to cultivate is to allow oneself to feel the vulnerability without a compromise in values and identity.  

In trying to understand those feelings of shame and vulnerability I have often found it helpful to see each partner individually for a couple of sessions in order to explore the origins of such feelings, when the dynamics in the room don’t allow for much reflection.  It is very common for the origins of shame to lie in early childhood experiences rather than the current relationship leading to feelings of low self worth and esteem.  The antidote to such destructive shame is self-compassion and empathy.  When each person can face these issues for themselves then they can begin to share with their partner and build a mutually supportive and nurturing relationship rather than a toxic and destructive one.  It is only by people learning to love themselves for who they are, rather than depending on the evaluation of others, that real growth can take place.

Other ways in which shame presents in the therapy room are in psychosexual therapy where issues around body image and sexual performance are frequently present.   The idea of a ‘perfect human’ is never far away from the pictures on our screens day after day.  It does not take much opening of the eyes to see that humanity is hugely varied and that very few people conform to these stereotypes but still those nagging, shameful accusations come – I am not like them -I am not good enough – I am worth less than others, so feeding still further that sense of shame. 

So what should a therapist be working on with a couple where shame is feeding a toxic relationship?  In my experience, it simply does not work to try to give the couple a set of exercises or top tips to rebuild things.  Rather through empathetic listening and a space to name feelings and have them accepted by a therapist, individuals can slowly be helped to build greater self-esteem and to discover, as they do so, that the shame they so greatly fear becomes less of a shadow in their lives.  Then in turn they can gain a greater capacity to accept and value their partner and real progress can begin to be made.

Sarah Fletcher