Shame and the Fear of Feeling

TOPIC. Toxic shame and the concomitant fear of feeling are core issues needing to be addressed during group therapy with adult survivors of childhood sexual abuse. PURPOSE. To increase awareness of the toxic shame that survivors experience and to describe the impact of group therapy based on a family systems model. SOURCE. The authors' clinical experiences. CONCLUSIONS. Symptom management, repatterning of cognitive distortions, and the improvement of self-care strategies are identified as crucial aspects of healing shame-based feelings and behaviors. Group treatment offers members the opportunity to cease reenacting family rules and roles that create toxic shame. Key words: Child abuse survivors, group therapy, sexual child abuse, shame Psychiatric clinical nurse specialists (CNSs), practicing in the arena of managed care, often are challenged to support and empower their clients in short-term, problem-solving endeavors. When dealing with crisis situations, the brief therapy perspective is advantageous. This model, however, is not the treatment of choice with women who were sexually abused as children (Courtois, 1988; Kepner, 1995; Kaufman, 1992). The core issue of shame and the concomitant fear of feeling usually escape resolution in brief therapy (Kaufman, 1992). Nurse-therapists working with women in individual and group therapy offer survivors the opportunity to manage symptoms, repattern cognitive distortions, and improve self-care strategies. Group treatment, using a family systems model, offers female adult survivors of childhood sexual abuse an opportunity to cease reenacting shame-based family rules and roles (Kreidler & Fluharty, 1994). The group becomes like a new family, promoting integration of new learning and allowing for reparation of shameful abuse experiences. Shame Shame as a concept is described frequently but seldom defined. Within early psychoanalytic theory, Freud's exploration of shame was limited by his focus on anxiety and guilt. He viewed shame as a social moderator opposing the pleasure principal. Shame was both reactive and inhibitive, relegated to the status of a defense mechanism (Broucek, 1991; Freud, 1905/1953). Other psychoanalysts have viewed the function of shame as promoting repression and blocking insight into one's own sexual dynamics (Kohut, 1971; Wurmser, 1981). Erickson (1950) viewed shame as a negative ramification of the second stage of psychosocial development. He identified the critical task of early childhood as autonomy versus shame and doubt. Mahler (1968), Kohut (1971), and Thomas (1997) expanded on Erickson's theory and related the child's need for unconditional parental acceptance and its primary influence on a positive sense of self. Within this school of thought, it was believed that shame developed from a failure in mastery of childhood tasks with a resultant view of the self as defective (Lewis, 1971; Morrison, 1989; Silverstein, 1993). Lewis described guilt as about what one does and shame about who one is. Theorists who are proponents of affect theory view shame as an innate affect (Broucek, 1991; Kaufman, 1996; Nathanson, 1992; Tomkins, 1963). Affect is regarded as primal over cognition, drives, and language. Shame, as an affect, functions to amplify awareness, moderate intensity, and protect one's humanity. It is seen as a positive mechanism in controlling behavior and offering societal boundaries. Pathological or toxic shame is presented as debilitating and restrictive in the expression of appropriate feelings. The development of shame and its residual effects can be viewed on a continuum. The positive end of the continuum illustrates the protection of one's humanity contrasted with the negative end of the spectrum, which manifests the destructive debilitating effects of toxic shame. Shame, then, is a complex human experience that can create unparalleled emotional misery. …