Sunday, March 5, 2017

The Analyst's Shame

We may go into this helping profession with fantasies of being all knowing, all powerful (to change others), and, especially, all loving. Our ambitions to change, help, or fix our patients collide with the reality that patients have symptoms and behaviors that sometimes must remain if the patient is to feel safe and unfragmented. Not discerning the purposes served by these necessary symptoms, our ambitions can fail and we feel helpless, incompetent, unseen, and useless. Thus, we may become angry with patients, as if they are incorrigible or recalcitrant. We may resent them for rebuffing our overtures to be helpful. We may become ashamed of our failure and of our negative feelings, as if  good therapists don’t get angry, good therapists don’t resent their patients.

Therapists can feel shame when talking about fees as if accusations of being greedy, uncaring, or sadistic hits too close to home. Therapists can feel shame about bodily infirmities such as when hearing loss, urinary urgency, gastrointestinal upset and other uncontrollable bodily changes are present. They can feel shame asking for referrals from more successful colleagues, or when litigation or completed suicide stigmatizes their practices.

If our expectations of ourselves are unrealistic and our assessment of ourselves harsh, we may respond to our mistakes with shame despite knowing that mistakes are inevitable, are useful learning opportunities, and can reveal heretofore unrecognized dynamics within and between patients and ourselves. Part of our shame can be resonating with our patients’ shame (e.g. projective identification) and thereby help us empathize with our patients’ experience. Owning up to our mistakes with our patients models survival of our own humiliation and may lead to more authenticity in the therapeutic relationship. Our patients’ forgiveness through repaired or continued trust can mitigate our sense of failure and shame.

Patients can experience a lessening of their shame in therapy when they find acceptance and empathy from therapists upon revealing what was once thought unspeakable, but when the therapists’ shame remains unrevealed, where do they find relief? Supervision with a nurturing and accepting, experienced colleague may help the therapist transform a grandiose ideal self into a more realistic expectation of one’s role as the therapist. Supervisors can remind us that patients value our dependability, our empathy, our trustworthiness, our ability to provide a safe space more than insight and perfection.

Weber.R.L. & Gans, J.S. (2003) The Group Therapist’s Shame: A Much Undiscussed Topic, International Journal of Group Psychotherapy, 53:4, 395-416.

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