Defenses Against Shame

Over the years of my practice, I’ve found that most clients who come into treatment struggle on some level with issues of neediness and shame.  In other posts, I’ve discussed difficulties in bearing need; now I’d like to address in detail three core defenses against the experience of unbearable shame:  narcissistic flight, blaming and contempt.  Denial of internal damage lies at the heart of all three defenses.  Feelings of basic shame also form the core of what is commonly referred to as “low self-esteem”.

Narcissism is the primary defense against shame and often goes hand-in-hand with the other two defenses.  When people suffer from an unbearable sense of shame, they often seek to elicit admiration from the outside, as if to deny the internal damage.  Beautiful outside versus ugly inside.  We’ve all known such narcissistic types.  As friends or acquaintances, they tax our patience and drain us emotionally because of their constant need to draw attention to themselves; their narcissistic behavior makes social interactions dull and one-sided.  Recognizing that these people suffer from unbearable shame may help
us to feel some compassion but it doesn’t make the relationships any more satisfying.

The shame-driven client poses a major therapeutic challenge.  If the therapist tries to discuss narcissistic behavior as a defense, to go beneath the “beautiful” outside and get closer to the “ugly” inside, it can easily feel to the client like a narcissistic injury, unbearably painful; rather than feeling that the therapist wants to help them get closer to  something true but unrecognized, such clients often feel humiliated.  I discussed such a client in my post on ‘Avatar’ and toxic shame avoidance.  As we got closer to the core of shame in our work together, whenever I tried to put him in touch with the damaged David hiding behind his narcissistic Internet encounters, he’d often begin to scream, accusing me of misunderstanding or purposefully humiliating him.  It felt to me as if the shame were so excrutiating that he had to “scream it out,” to rid himself of that searing pain and project it into me.  As his therapist, I found the experience deeply painful but at the same time, it helped me understand the degree of his suffering, the intense pain he was constantly warding off.

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Merger Fantasies in Psychotherapy

Certain clients, especially those with personality disorders or issues related to bipolar disorder symptoms, often idealize their therapists, putting them up on a pedestal and worshipping every word they say.  Behind these feelings often lies a desire to merge with the therapist and to take part in that ideal life as a means of escape from personal torment.  These ideas of merger represent a kind of growth-by-annexation where, in fantasy, the client wants to get inside of and take complete control over the therapist.  This wish usually goes hand-in-hand with a belief that the client’s own internal world is so damaged as to be beyond repair; they believe this magical usurping of the therapist’s identity represents their only hope to get better.

As a therapist, you might notice that the client starts talking like you, echoing your phrases and speech patterns or developing a collegial manner in your relations.  Such fantasies of merger are especially visible in dreams, however.  Two dreams from one of my clients, someone I saw many years ago, illustrate the dynamic very well.  He entered treatment because of occasional but severely debilitating depressions in which he felt unable to work.  On the surface, Jim (mid-20s) appeared extremely appreciative; he was always telling his friends that I was a wonderful therapist and every week he’d repeat to them my “brilliant” interpretations.  He’d been in treatment for a few months when he brought in the following dream.

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Emotional Dependency and Stealth Control

In my psychotherapy practice, I’ve had a number of clients who suffered from emotional dependency issues:  in their personal relationships, they often seemed helpless and extremely needy.  I’m sure you’ve known such people.  They may appear clingy and possessive; they often get involved with someone very strong and competent, a Rock of Gibralter type.  In extreme cases, the relationship consists almost entirely of one person taking care of the other.  Incapacitating depressions may be frequent or continuous, to such an extent that the emotionally dependent person may be unable to hold down a job or function as an independent adult, so completely reliant on the other person that at times he or she seems infantile.

As clients, such individuals quickly become dependent on treatment for support.  Even if they’re coming for more than one session per week, the gap between those sessions will feel too long; they may make frequent “emergency” calls on weekends or in the middle of the night.  If a therapist isn’t careful, such clients can become extremely taxing and emotionally draining.  We may feel intense pressure to provide emotional relief; if we’re not empathic or supportive enough, these clients may become intensely angry with us.  In some cases, it actually feels like a relief when they quit in a rage and seek treatment elsewhere.

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Autism Symptoms in Other Disorders

[NOTE:  The following article discusses autism symptoms that may appear in other psychological disorders of adolescence and adulthood; for information on how to recognize and distinguish autism from other early childhood disorders, please click here.]

One of my clients, a young woman in her 20s, would come into session and sit for long periods in silence.  She found it almost impossible to make eye contact.  Later, I learned that she was mentally “singing” brief repetitive songs she herself had composed.  Usually they were but a few bars repeated over and over.  Or she might get a famous song “stuck in her head” and keep the loop running.  The Beatles’ “She’s Got a Ticket to Ride” was a favorite.  At those times, I felt as if she were shutting me out, almost as if I didn’t exist.

At other times in our work, she would communicate with me and use words in a normal way, although she was quite troubled and in a great deal of obvious pain.  She had a few stormy friendships; she mostly dated women and developed one intense, merged relationship that lasted more than a year.  In terms of background, she came from a chaotic and emotionally violent family;  she remembers as a small child regularly crouching behind a chair in the living room, intoning a single word over and over in a monotone way.  She had other such repetitive rituals that soothed her.  She also recalled an early childhood fascination with small hard objects and continually pressing them into her hands.  She didn’t like soft toys.

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Unbearable Emotions and Feelings

The term “eating disorders,” like so many diagnostic labels, describes a spectrum of experiences and dynamics; while two people might both overeat and purge, the psychological reasons why they do so can be very different.  I’d like to discuss one of my clients who suffered from bulimia, along with the emotional factors involved, because her story sheds light on a much larger issue:  how we may cope with unbearable emotions and feelings by trying to get rid of them.

When I began working with this client (I’ll call her Sharon), I had little experience with eating disorders. I understood that there might be a connection between childhood sexual abuse and bulimia; I was aware that low self-esteem and perfectionism likely played a role.  The first time we met, Sharon told me she’d been sexually molested by her step-father during her early teens; while she didn’t strike me as having particularly low self-esteem, she did seem quite perfectionistic and self-critical. In our early sessions, however, what struck me most was how little she could tolerate her emotions and feelings.

A pattern began to emerge:  whenever an experience threatened to stir up emotion (it could be an intensely pleasurable feeling just as well as an anxious or painful one) the powerful urge to overeat would arise. Eventually she would give in, binge eat and force herself to vomit afterward; an enormous sense of relief always followed.  We came to understand that what she wanted was to feel empty, void of emotion.  Her bulemia, in a very literal sense, was a process of emotional evacuation.  By throwing up, Sharon felt she’d gotten rid of the unbearable emotions and feelings along with the food she’d eaten.

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