Further Thoughts on Shame

Shame is a central concept in understanding the traumatized children with whom we work. Our work becomes more sensitive and thoughtful when we remain aware of the profound shame operating in our children, and remember how it affects everything they do.

When I was training with Laurie Pearlman, Ph.D. (Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors; written with Karen W. Saakvitne, Ph.D.; and http://www.heal-reconcile-rwanda.org/) last week, she added some further thoughts on shame.

The first concept is that the opposite of shame is contempt. Or, to put this another way, contempt is the escape from shame. When a person feels unbearable shame, he lessens the anguish by moving into contempt: I feel less horrible in comparison to you if I can act as though you are worthless, beneath my notice, not worth caring about. If you can be made contemptible, I will feel relatively all right. Therefore, if we do not address the shame, the children may treat us with contempt.

Laurie also quoted Donald Beere (http://home.insightbb.com/~donaldbeere-phd/index.htm) as describing shame as composed of two parts: being disconnected and being less than. A person feeling shame feels separate from the human race. I am other, I am uniquely bad and unlovable. And the person feels not only separate, but less, worthless, lower.

It follows from this that shame can be healed in two ways (preferably both). The first is to establish the connection- you are like us, you are part of us, we care about you, keep our caring in your heart even when we are not physically with you. All the methods we know to form, honor, intensify and internalize relationships address this part of shame- the disconnected part.

The “less than” part can be healed through any development of competence and self worth, and also by information. We give information about trauma and its effects, for example. Your symptoms are not signs that you are crazy, they are the expected human reaction to trauma.

Isolation, restrictions, and banishment would seem almost designed to reinforce both aspects of shame- separate the child from connection, and re-affirm for him through punishment that he is definitely less than others.

If shame is not healed, the person continues to act to prove how awful they are, and continues to reject caring and closeness as impossible to achieve.

Both parts of shame are healed through authentic relationships.

They Are Us

Last week I was honored to do a Risking Connection (RC) training with one of the original authors of the curriculum, Laurie Ann Pearlman, Ph.D. Laurie is an internationally known expert in trauma and vicarious traumatization, and her book: Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy With Incest Survivors written with Karen W. Saakvitne, Ph.D. (another Risking Connection author) contains the theory behind the RC curriculum and elaborates the content. (http://www.amazon.com/gp/product/0393701832/qid=1148758585/sr=1-2/ref=sr_1_2/102-3747173-8619359?s=books&v=glance&n=283155)
Laurie also works in Rwanda helping to heal the trauma caused by genocide in that country, and details of her work there can be found at: http://www.heal-reconcile-rwanda.org/

Laurie speaks eloquently on the subject of vicarious traumatization, an inevitable result of doing treatment with trauma survivors with an open heart. VT is defined as the negative changes in us that occur over time as a result of doing this work. RC emphasizes awareness of VT, and that the practitioner has an ethical imperative to monitor and address VT symptoms in his/herself in order to maintain hope and connection for the clients.

As Laurie spoke of what we can do to minimize and heal VT in ourselves I was struck in a new way that what we need is exactly what we are saying our clients need. Treaters need respect- the audience responded so powerfully to the acknowledgement of the effect the work has on them. We need information- that VT is inevitable, it is normal, it is not our fault or the fault of the client, that it can be minimized, addressed and transformed. Information is also important because when we have a theoretical treatment approach, a map, a strategy, we do not feel as lost and overwhelmed. We need connection- to have a community at work and at home that we can talk to, with whom we can share the pain and the triumphs, and who will not judge us. And we need hope- to know that abuse survivors do heal, and treaters do endure and in fact grow and thrive in the profession.

Suppose I suggested that as agency staff we would benefit from a reward system that gave us extra privileges (later bedtimes, more status) whenever we addressed our VT pain. The system would also punish us by banishment and restriction when the pain over came us and we did a VT behavior such as over-eating, or zoning out in front of the TV, or being less than responsive to a client. Maybe there would be some short-term gain in such a system. But do any of us feel that would be the most powerful way to help us overcome our vicarious traumatization?

We know so deeply what we need, and what we respond to. Why is it so hard to imagine that our clients need exactly these same things?

I Statements

Recently someone asked me whether it was really a good idea to encourage staff to speak about their own emotions when talking with the kids. We encourage staff to speak from the heart, and to use I statements. Examples would be: “when you ran away, I was so worried about you. I couldn’t sleep because I worried that something bad would happen to you.” Or, “You just hit me. I am not ready to give you a hug. I feel hurt and upset right now. I’m sure we can work this through later but right now I need some time to calm down before I can reconnect with you.”

What are the objections to this approach? People worry that staff will be emotionally out of control, and will be too intense/vehement/dysregulated in their response to the kids. Will the staff be using the kids to meet their own emotional needs? Will the staff emotion be overwhelming to the kids? Will the staff forget that they are the professionals and being paid for the work?

And there is also some concern that staff expressing distress, hurt, worry or other personal reactions will interfere with giving the kids unconditional positive regard.

In my experience, staff members’ emotional reaction to being hit, kicked, bitten, to the kids being mean to them, to the kids running away, is always a part of what is happening in the treatment. If staff has no direct way to express those emotions they will act them out, through excessive harshness, through distance, through over-involvement. And no one ever feels unconditionally positive about anyone, and it is dishonest to act as though a staff feels completely positive about a child who has just physically hurt them. Better to have the real feelings in the open in a controlled way, to be worked through and transformed.

But even more importantly, children learn emotional regulation through relationships with emotionally regulated adults. How better can a child learn what to do when something goes wrong, than through a close connection with a staff member who is deeply affected by an event, but then mends the relationship? Authentic relationships are the source of healing. How can a relationship be authentic if one person is not allowed to make I statements?

There is always the possibility that there will be emotionally dysregulated staff, staff with poor boundaries, staff with over-intense reactions either positive or negative. That is true no matter what system you use, no matter what instructions you give them. This becomes first of all a team issue, because a well functioning team will allow staff to confront each other directly on such matters. It also becomes a supervision issue to be handled directly and vigorously by the unit manager.

If we don’t trust the staff to have real, straightforward relationships with the kids, how can we leave the kids in their care? We have to teach people how to speak from their hearts, while maintaining good boundaries and emotional regulation. If we do not do this, we lose the most powerful tool we have: ourselves. We rob the kids of the reparative experience of good, flexible, calm relationships.

Rob and Jonathan

When Rob came to us, he was extremely aggressive. He assaulted staff, got arrested, broke things, and repeatedly lost control. We were not at all sure we could continue to treat him. Rob’s mother had placed him at Klingberg and said she did not want to see him again. His dad was initially involved, but then got caught up in his own life difficulties and became less available to Rob. His mother, however, gradually started limited visiting and contact, and then began participating in therapy.

After much time, Rob told his therapist that he had always felt he wanted to be a girl. He stated that he prefers women’s clothes and that he wanted to get an operation to become female.

Rob entered a period of experimenting with women’s dress, a little at a time. He would try something such as a female blouse, and then stay with male clothes for a while. He spoke in group and in family therapy of these feelings. At times he felt great urgency and demanded to have an operation that afternoon. At other times, he was not so sure.

As Rob became more blatant in his female dressing, and started wearing a female wig at times, many staff reacted. Some felt we should forbid this, that it was wrong. Others felt compassion for the struggle this young person was experiencing.

The kids by in large were supportive to him. He had shared his feelings with them, and he is well liked. The kids can be amazingly kind and tolerant to each other when it comes to important issues.

Jonathan, however, was back from the hospital. Jonathan has always been mean to others, especially anyone he sees as vulnerable or anyone who makes him uneasy about himself. He does not know another way. So he started saying nasty things to Rob, and tried to rile the other kids up against him. They weren’t buying it. So Jon went over and pulled Rob’s wig off. Rob hit him.

In the old days, punishment would set in. Rob would receive restrictions for assault, Jon for instigating. Both would be in their rooms for long periods of time. The restrictions would eventually be over, and both would emerge angrier than ever and more sure than ever that the other was alien, and evil.

Yet what a learning opportunity for both boys! Jon has to develop ways to handle people who make him uneasy without such meanness. Rob may face hazing and even people touching him throughout his days if he continues in this path.

So, Jon sat down with his therapist and wrote up a list of questions to help him understand Rob better. They included: why do you want to dress like a girl, have you always felt this way, why did you react as you did, etc. Rob answered the questions very seriously in writing. At the end of his answers Rob wrote: “Please feel free to ask me anything else you want to know about this. I will answer any questions if you ask them respectfully.”

Jon is still uneasy about Rob dressing as a girl, and thinks he is weird. But he can see Rob as a person with a struggle. Rob doesn’t exactly like Jon, and he also knows that many people will react to the choices he is making. And he can understand their confusion.

Both boys have emerged from this event wiser, and with just a little more skill in handling the many difficulties life will give them.

Self Capacities

Risking Connection (www.riskingconnection.com ). is a foundational trauma theory course. The basic premises are that symptoms are adaptive, and that they are best healed within a RICH relationship (one containing Respect, Information, Connection and Hope). The underlying trauma framework is that:
Childhood traumatic experience(s) lead to traumatized development, which includes disrupted attachments, a sensitized nervous system, and impaired self-capacities. These self capacities are: inner connection, self worth, and feelings management. When the youth encounters a current stress, he or she experiences an intolerable emotional state. He only knows negative/extreme coping strategies. We call these coping strategies symptoms. They include: retreat, self-destruction and other-destruction.

The only path to decreasing these symptoms, preventing crisis, and helping the youth to have a life worth living is to increase the self capacities. The youth must learn how to keep a sense of a loving connection to others even when the other is not physically present. She must develop a sense that she is worthwhile and deserves to be alive. And she must learn feelings management skills.

So when a child has had a behavioral problem, how can our response help him develop these capacities? Our first step would be (in advance of a crisis) to assess which of the skills he particularly lacks (many of our clients do not have any of them), and which skill deficits tend to lead to the most problematic behavior.

Then our Restoration for the behavioral issue can focus on activities that develop these skills.

To develop a sense of a loving connection, the child could: write a list of people who love her, collect affirmations from people and put in a box to read in times of difficulty, make a poster of pictures of people or magazine pictures that remind them of positive people in their life, or chose a staff member she likes and interview him or her and write a magazine article about them.

To increase their sense of being worth while, a child could make something or cook something. He could make a list of his skills and his accomplishments with staff. He could do something for others- read to the younger children, collect food for a food pantry.

To learn feelings management skills a child can utilize a feelings chart or thermometer. She could make posters to explore her feelings. She could do a chain analysis. She could practice relaxation techniques, make a list of distraction activities, or create a crisis kit.

Children will change and grow when they master the skills they missed during their development, and thus become able to survive life stress and to make, keep and remember loving relationships.

Books and Resources

I have been reading the book Creating the Capacity for Attachment by Arthur Becker-Weidman, Ph.D. and Deborah Shell, MA. This book further advances the theories we are working from, building on and expanding the ideas of Daniel Hughes, Ph.D. (Building the Bonds of Attachment). The book also gives two examples of using these theories in residential treatment centers: Villa Santa Maria in Santa Fe, New Mexico and Chaddock in Quincy, Illinois. The book is most helpful because it includes many specific examples, tips, techniques and practical suggestions. The author’s web site can be found at: http://www.center4familydevelop.com/.

I came to these authors through seeing Bryan Post at a workshop and being impressed by his teaching. B. Bryan Post, PhD, LCSW is the co-founder of the Beyond Consequences Institute, LLC. Dr. Post is the author of "For All Things A Season", "Dr. Post's New Family Revolution System", and co-author of "The Forever Child" series. He is an internationally recognized specialist in the treatment of emotional and behavioral disturbance in children and families. Dr. Post specializes in a holistic family-based treatment approach that addresses the underlying interactive dynamics of the entire family, a neurophysiologic process he refers to as, "The secret life of the family." As an adopted, and well-known disruptive child himself ("I've set fires, killed animals, and stolen compulsively."), Dr. Post has made it his primary work to speak to parents and professionals from a perspective of true-life experience and in the 'trenches' therapeutic work. More information can be found on Dr. Post and the Post Institute at: http://www.postinstitute.com/

I have also recently read Bryan Posts’ latest book: Beyond Consequences, Logic, and Control: A Love-Based Approach to Helping Attachment-Challenged Children With Severe Behaviors Heather Forbes, LCSW and B. Bryan Post, Ph.D., LCSW
http://www.beyondconsequences.com/. The main tenant of this book is that fear lies below all the acting out, difficult behavior of the children we treat. Therefore, the most effective interventions are those that identify and sooth the fear. This book also has many examples and specific techniques to address specific problems children may demonstrate.

Heather Forbes hosts an email listserve on which parents post for support and advice. It can be found at: http://groups.yahoo.com/group/DailyParentingReflections/

Conference Presentations and Training

We have been accepted to present our new methods in a workshop entitled: Creating a Culture of Connection: Transforming Residential Treatment for Severely Traumatized Children at the 11th International Conference on Violence, Abuse, and Trauma, scheduled for September 14-19, 2006 at the Town and Country Resort & Convention Center in San Diego, California. http://www.ivatcenters.org/. We have also been accepted to present at the Alliance for Children and Families 2006 National Conference. The 2006 National Conference will be held October 18-20 in St. Louis, Missouri at the Hyatt Regency, St. Louis at Union Station www.stlouis.hyatt.com. Contact Hillary Hanson with any questions. We appreciate these great honors and are looking forward to these events. We continue to get requests for training and consultation. At this time we have scheduled many Risking Connection trainings (www.riskingconnection.com) throughout the months of May and June.

We will be holding a 3-Day Basic Risking Connection Training July 12, 13 and 14, 2006 at Klingberg Family Centers in New Britain, CT. (www.klingberg.org) This training is open to any professionals who work with traumatized young people.

It is interesting and exciting to be participating in these trainings. Each time we meet new groups, talk over these approaches and connect with their concerns and fears it helps refine the theories and the practice.