Shame-Informed Therapy: Debunking the Lies That Shame Tells Us

“If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can’t survive.” — Brené Brown

At some point in our lives, most of us have had an experience where we felt we were not good enough in some way. As a result, just about all of us know what it’s like to feel shame.

Shame is a complicated emotion. We are first able to experience shame around the age of three, and it can feel somewhat different from person to person. However, shame is always about hiding some part of ourselves from other people. When we feel ashamed about something, we are desperate to keep it hidden from others, because we fear that they will judge us negatively for it. In fact, the word “shame” is believed to come from an old Indo-European word meaning “to cover.”

Not only is shame upsetting to experience, but deep-seated shame can create a variety of challenges in a person’s life. Shame can make relationships with other people difficult, and it can also complicate mental health conditions like depression, anxiety and PTSD. Shame is also deceptive by nature: shame tells us lies about ourselves, and if we believe these lies, they can cloud our judgment, interactions with others, and belief in ourselves.

Shame-informed therapy is a model of care that we are currently integrating into our services here at Cummins. This model is informed by modern neuroscience, which shows how activity in our brains and nervous systems can directly affect our thoughts and emotions. Most importantly, shame-informed therapy offers a pathway for overcoming shame and accepting ourselves for who we are.

Robb Enlow, our Chief Clinical Officer, is currently leading trainings to teach shame-informed therapy to our service providers. In this blog post, he explains how this approach to treatment can provide hope for those who struggle with shame and other related challenges.

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Robb Enlow, LCSW, Chief Clinical Officer at Cummins BHS

Explaining Polyvagal Theory, the Foundation of Shame-Informed Therapy

Before we can talk specifically about shame and shame-informed therapy, we need to explain a concept known as polyvagal theory.

You’ve probably heard of a phenomenon called the “fight or flight” response. When a human being encounters a threatening person, creature or object, it’s crucial that they determine how to stay safe from this aggressor. In some situations, fighting the aggressor may seem like the best option for maintaining safety, while in others cases, fleeing from the aggressor might seem more practical. This decision often happens quickly, without much conscious thought, and is controlled by the sympathetic nervous system.

However, there is a third response to danger that a person might also choose, which is to stay very still, or “freeze.” Freezing behavior is sometimes an attempt to avoid being seen by an aggressor, which could be the best option if fighting or fleeing doesn’t seem possible, or it may result from an extreme stress response that temporarily “overloads” the nervous system. Freezing behavior can often be observed in children (as well as in animals), and according to polyvagal theory, this reaction is controlled by the dorsal vagus nerve and related dorsal vagal complex.

Fight, flight and freeze are all responses to danger that can increase our chances of survival. However, these responses also limit our ability to perform higher-level thinking and reasoning. When we are fighting, fleeing or freezing in response to a threat, we aren’t wondering if we can appease the threat or considering whether or not it truly is a threat to us. We are simply thinking about survival. In essence, we are physiologically “locked out” of higher-level cognitive processes.

According to polyvagal theory, these higher-level processes are only possible when the ventral vagus nerve and ventral vagal complex are activated. Importantly, this nerve is also associated with social engagement and emotions like joy, compassion, curiosity and mindfulness.

Shame in the Context of Polyvagal Theory

What does polyvagal theory have to do with shame? As it turns out, polyvagal theory does a good job of explaining what happens when someone experiences shame.

“From a neurological standpoint, shame functions like trauma in a lot of ways,” Robb explains. “Trauma and extreme periods of shame, particularly between the ages of three and eight, kind of captivate or capture people into this frozen state.”

As we mentioned above, freezing behavior is common among children who are experiencing emotional distress. Due to their youth and limited life experience, young children are easily overwhelmed by negative feelings and emotions. As Robb explains, frequent activation of the dorsal vagal complex—which triggers the freezing behavior—can lead to trauma and shame that gets carries into adulthood:

“Research shows that between the ages of three and eight, the nervous system is developing at a very quick rate within the child. The nervous system is beginning to make connections in the brain about, ‘This is how I feel when this thing happens.’ It could be as simple as, I look at something disgusting, and I think, ‘Ew, that’s gross!’ while I feel unwell in my body. That feeling relays through my nervous system back to the brain, which I then make meaning of when I say, ‘Oh, that’s gross. Don’t touch that.’ That process continues as people begin to make meaning of the world.

Now, I’m going to make up a story. A three-year-old girl starts to play with older brother’s boys’ toys. Mom says to the three-year-old girl, ‘Little girls don’t play with that. That’s not yours. You play with dolls.’ Or maybe the three-year-old girl says, ‘I don’t want to wear a dress, I want to wear pants.’ And mom says, ‘No, bad! Girls wear dresses, not pants.’ These are just single instances, but think of all the times when people get told ‘no, bad.’ What happens is, when they’re told that, they go into that frozen state. They go into that place where there’s that painful feeling, and it forces people to do one of two things. They either become engulfed by it, or they hide from it, they avoid it.”

The Self-Lies of Shame

When young children are subjected to this kind of criticism, they can easily internalize it. Over time, they might come to believe that they are “bad” or “not good enough.” In many cases, these negative self-beliefs are carried into adulthood, resulting in shame.

Because shame is such an unpleasant emotion, most people develop strategies for avoiding it. Robb explains, “This is how we develop what’s called the ‘masks of shame.’ These essentially become parts of ourselves that get easily triggered by other things that remind us of that past pain. Deep down, we know we don’t want to feel that pain, so we exile that part of ourselves. We try not to go into that frozen state, and instead, we develop cover-ups.”

These masks and cover-ups are related to a fourth kind of response to danger known as “fawning,” or hiding our true self in order to feel safe. Some common masks of shame include self-beliefs like “I’m a bad person,” “I’m not good enough,” “I’m a failure,” “I’m a fraud,” and “I’m unlovable.” These masks may be covered up by behavior like shyness, secret-keeping, lying, co-dependence on others, substance use and addiction, and controlling behavior. But over time, these covering behaviors can actually reinforce the negative self-beliefs they were meant to hide.

All of these masks and corresponding behaviors can be highly destructive to the self and others. However, shame is almost always based on false beliefs. Put more accurately, shame results from false self-beliefs and misunderstandings about the origins of our behavior—behavior that was intended to help us feel safe and avoid our shame.

Robb explains in greater detail:

“I always like to tell people that shame is a lie, because it’s a cover. It’s always about not feeling what, for whatever reason, the body is trying to feel. And so shame will always have the ability to lie to people. It’ll always have the ability to tell people they’re not good enough, and they will even argue it as though it were the truth. It’s not until they recognize the origin of that shame, and how that origin played into their ability to maintain safety, that they realize, ‘OK, that had a reason. That had a purpose. And I can maintain my purpose and my safety without maintaining that behavior, that pattern.”

How Shame-Informed Therapy Helps Us Reprocess Shame

If we understand the root of shame, then we can understand how to eliminate shame. This is precisely what shame-informed therapy is designed to do.

“If I had to summarize it, you help people connect six things,” Robb says: “Feelings, body sensations, early memories of those feelings and body sensations, what core beliefs have developed in response to those memories, how are you really authentic today, and how can you create a new story to align all those pieces? That’s the process. You help people connect the dots with those things by gently talking about it in a safe environment.”

As we’ve discussed, revisiting or re-living feelings of shame is often an upsetting experience. This can emotionally and physiologically “trigger” someone, sending them into a defensive posture of freezing, fighting, or fleeing. In shame-informed therapy, every effort is taken to keep the ventral vagal complex activated so the individual can cognitively reprocess their shame. Robb explains,

“Part of what any therapist, nurse, teacher, or communicator has to do with other people is co-regulate. If you’re in an ugly frozen state, and the person you’re communicating with is in an ugly frozen state, that’s not a pretty conversation. In fact, sometimes we see that clinically. The parents are frustrated and triggered, the child is screaming and triggered, and neither one of them are communicating effectively with each other. They’re both frozen or very ‘fight or flight,’ and it’s just not working for them. The idea is we get them regulated to the ventral vagal state, or the social engagement state. When people are truly in the social engagement state, that’s when your brain is able to do miraculous things. When you calm down those cover ups, those protective, defensive parts, the rest of your brain is able to access creative, curious things that you’re just not able to access when you’re not in that state.

According to Robb, the ultimate goal of shame-informed therapy is to help people re-frame the beliefs and behaviors they feel shameful about. This process can help someone see that the behaviors they are ashamed of were always intended to help them feel safe:

“The good part about treatment is you can actually rewrite the way that the brain interprets information. The person who’s always believed, ‘I’m a bad person, I can do nothing right,’ maybe now has a new belief that, ‘OK, maybe I was never bad, maybe that’s what I had to do to get through the horrible trauma that I endured.’ In shame-informed therapy, this is what we call respecting and honoring the survival nature of what people have had to do to feel safe. That’s the key element there. If someone says, ‘Oh, I did that because that must be something I did that’s wrong,’ I’ll challenge that with, ‘No, you did that because that, at the time, is what you had to do to feel safe. And if you didn’t do that, I don’t know if you would be here today.’ And that’s hard for people to come to terms with, that, ‘OK, this very thing that causes me agony is also what’s helped me to establish who I am and feel safe.’ “

Shame is among the most difficult emotions that we can experience in our lives. Shame makes us believe that we are inferior or flawed, and to avoid feeling this way, we may develop behavioral patterns that harm ourselves or others. If we hope to overcome shame, it’s essential that we examine its origin, understand how it has influenced our behavior, and recognize the lies it has made us believe about ourselves.

If you are struggling with shame and would like to talk to a professional therapist or counselor, we have care providers who can help you. We invite you to give us a call at (888) 714-1927 if you would like to learn more or discuss treatment options. You are capable of living a life free from shame!

National Recovery Month 2021: Supporting Recovery from Substance Use Disorder in our Community

Substance use disorder continues to be a massive problem in our society. According to statistics from the National Survey of Drug Use and Health, approximately 20.4 million people lived with a substance use disorder in 2019. In addition, it’s estimated that around 25 million people are in stable recovery from substance use disorder, meaning they have been successful in sobriety for one year or longer.

Even though we know more about the science of addiction than ever before, there is still a significant amount of stigma surrounding this subject. Individuals who struggle with substance use may be considered undesirable by some segments of society, and this prejudice may persist even after someone has been successful in their recovery for many years. For this reason, some people like to keep their recovery private, only discussing it in certain circles—which was one major appeal of Alcoholics Anonymous when that program first started.

However, times have changed since then, and a growing number of recovering individuals no longer want to be anonymous. Instead of feeling ashamed of their past substance use, they prefer to feel proud of their new lives in recovery, and they want to share their stories with others. This is the purpose of National Recovery Month, which this year focuses on the theme, “Recovery is for everyone: every person, every family, every community.”

Indeed, we can all play a part in supporting recovery in our communities, and there are many ways to help or receive help. We spoke with Erin Flick, our Substance Use Disorder Team Lead for Putnam County, to learn more.

Erin Flick, MSW, LCSW, LCAC, Substance Use Disorder Specialist and Team Lead at Cummins Behavioral Health
Erin Flick, MSW, LCSW, LCAC, Substance Use Disorder Specialist and Team Lead at Cummins Behavioral Health

Why National Recovery Month Matters

First observed in 1990, National Recovery Month is an annual celebration of the gains made by individuals in recovery, as well as of the treatments, recovery practices and community supports that have helped them along the way. “It’s an opportunity to bring awareness to recovery, as well as an opportunity for community stakeholders to come together and celebrate one another, and celebrate sobriety,” Erin says.

In recent years, there has been a growing movement in the recovery community to reject the stigma of substance use disorder and instead focus on the accomplishments of those in recovery. Erin explains, “Sometimes we’re tucked away in meeting rooms or in church basements, not always living out loud. We experience stigma every day in regards to substance use disorder. But about a decade ago, there was a surge in the recovering community, and we no longer want to be anonymous.”

Over time, public opinions about substance use disorder have started to change. Although stigma still remains, many people now know that addiction is a disease rather than a discipline issue, and our language for talking about addiction has become less discriminatory. Every year, the focus of National Recovery Month is on continuing these advances, as well as on supporting everyone whose life has been impacted by substance use disorder. As Erin says,

“It’s always nice to come together and celebrate, because with the disease of addiction, there’s so much trauma, tragedy, and premature death. But the great thing about the culture of recovery is that it’s more about the celebration of life and healing. And the most important piece is welcoming newcomers, showing them that they’re not alone, and showing them that if we can do it, they can do it.”

How You Can Support Others on Their Journey of Recovery

Although the stigma surrounding substance use disorder is lessening, and more individuals want to be “in the open” about their recovery, the fact remains that those in recovery need support from friends, family members, and their communities. Addiction is a chronic disease, and recovery from addiction is a lifelong process. Care and support from other people can often make the difference between continued sobriety and painful setbacks.

For both recovering individuals and those who know someone in recovery, Erin emphasizes the importance of open and honest communication. “For family or friends, my overall advice is just to talk out loud, to whomever, and eventually you’re going to get linked to something that might be beneficial for supporting that individual,” she says. “And for someone who is in recovery, the same thing: tell your story out loud, because you may say something that impacts someone who is struggling or a family member who doesn’t know what to do.”

However, if you do not personally have experience with substance use disorder, the first step is to seek to understand those who do. Erin explains, “As human beings, it can be easy to judge and take other people’s inventory. A lot of times, drugs and alcohol are a symptom of deeper issues—usually of trauma. If we listen to understand, then we can gain insight into an individual and their circumstances and have empathy, and by doing that, we can build knowledge about the disease of addiction.”

Finally, Erin stresses the importance of connecting with recovery-oriented organizations and participating in the recovery community:

“Do your research, get connected to community resources, and see what you can do, because we can’t do it alone. It takes a village. And a recovering community is a lot healthier than a community that says, ‘Not in my backyard.’ We can help individuals who are struggling become active participants of the community, whether it be through offering jobs, treatment, or an in-kind donation to a community resource. By the time someone gets to a point where they’re ready to make a change in their life, they might have nothing. So it’s about reaching out to the community to see how you can help. I just did this with a community member this week. In order to get them into sober living, where they really needed to be, it was going to cost $130 for their first week. I reached out to a church, and because they are recovery-informed, they committed to sponsoring the first week so this individual could get into sober living and be safe.”

Helpful Resources for Recovery

Fortunately, getting involved in your local recovery community isn’t difficult. There are many existing support groups for both individuals in recovery and those who know someone in recovery. Below, we’ve made a list of some of our favorite support organizations, as well as websites you can visit for useful facts and statistics about substance use and addiction.

Recovery & Support Groups
Learning Tools

Cummins Behavioral Health is proud to be an advocate for every person whose life is affected by substance use disorder, including all those who are successfully living their lives in recovery. This National Recovery Month, we encourage you to get involved in your local recovery community, seek support for your recovery if you need it, and “live out loud” regarding your personal experience with addiction and recovery!

If you know someone who could benefit from the information and resources in this article, please share it with them! Your care and support can make a lasting impact on someone else’s life.

Cummins Values: How Our Providers Inspire the Hope of Recovery

Take a moment to think about the importance that hope plays in your day-to-day life.

When you find that your current life circumstances don’t live up to your expectations, does hope for a better future help to improve your outlook? When you are faced with adversity, does hope help you push through the obstacles in front of you?

Or even worse, have you ever felt hopeless about some situation? If you have, then you surely know how demoralizing it can be. When we feel hopeless, we have no motivation to strive for something better, and we may also be vulnerable to experiencing mental health problems like distress, depression and anxiety.

Just as hope is important in life, it is also essential in recovery from a mental health challenge. Recovery from mental illness and addiction is not only possible—it is a journey of healing and transformation that enables individuals to live meaningful lives and to achieve their full potential. At Cummins, we believe in everyone’s potential for growth, change, and recovery, and we recognize that one of our primary roles is to help instill the hope of recovery in the people we serve.

In fact, hope of recovery is one of the core values that guides our organization and the work we do each day. To better understand how we inspire hope for our consumers, we spoke with four members of our staff who embody this value: Molly Pennell, Wraparound Facilitator and Master-level intern; Jenna Batta, Wraparound Facilitator; Christine Watson, Intake Specialist; and MeLinda Frazee, Licensed Mental Health Counselor.

In this post, they explain what hope of recovery means, why it matters, and how they strive to inspire hope for the individuals they serve.

What Does Hope of Recovery Mean?

Molly Pennell (left); Christine Watson, LCSW (middle); and MeLinda Frazee, LMHC (right). Not pictured: Jenna Batta, BS.

When discussing the hope of recovery, it’s important to first explain what this concept means. We all know what it’s like to feel hopeful about something, but what exactly does it mean to have hope of recovery?

In its simplest sense, hope of recovery is the belief that we can get better from whatever challenges we face and live happy, healthy lives. However, our providers offered some additional definitions that expand and enrich this meaning.

For example, Jenna believes that hope is about focusing on progress toward our goal rather than any setbacks that arise. “Hope of recovery means keeping your eye on the big picture so that you can remind families when the difficult days are becoming less and less and that their overall mental health is getting closer to their goals,” she says.

Molly points out that hope of recovery is also about how care providers interact with the individuals they serve. “For me, hope of recovery means showing encouragement, a positive attitude, and kindness to every person who enters our doors regardless of their situation or their current stage of change,” she says.

Christine agrees, noting her important role as one of the first individuals a consumer will interact with when entering services: “For me, the hope of recovery means that when people get started in services, they know that they will have someone who is going to be there with them as they walk through their journey—someone who will encourage and support them.”

Finally, MeLinda likes to focus on the transformative effects that hope can have for someone in recovery. She explains, “For me, hope is about supporting a client’s desire to live an authentic life.”

Why Hope Matters for the Recovery Process

Above, we illustrated the difference that hope can make when we are faced with a difficult or discouraging situation. The truth is that entering mental health services can be quite difficult for many people. Suddenly, we have a problem we need to address and much work to do before we might feel well again. So how exactly can hope helps us throughout our recovery process?

For starters, hope is one of those forces that helps us keep going when the going gets tough. Jenna explains, “Hope is like an urge or an internal motivator. If we are having a hard day, we need something within us to remind us to move forward every moment, and recover from the bad days, whether that means owning up to our mistakes or simply trying again.”

As we mentioned, the recovery process can often be a difficult one, so hope is necessary to help us keep pushing forward. “I believe that hope is important in the recovery process because going through it can be scary, unfamiliar and uncomfortable,” Christine says. “It takes a lot for people to come in and start in services. It is important to instill hope in them throughout.”

Importantly, Molly points out that hope works because it focuses our attention away from negative present circumstances and toward positive circumstances we hope to achieve in the future. “Hope is essential to the recovery process because people need to know that things can get better, people can make positive change, circumstances do change, and there is hope for a more positive future. Hope can set a person up for success,” she says.

And again, MeLinda connects hope to authenticity, suggesting that hope helps us achieve the life we truly want for ourselves. “Much of the time, individuals start to work with me and don’t believe that the life they desire is possible,” she says. “I help them see that there is hope that they can have a successful job, positive relationships, increased self-worth, maintain their sobriety, etc. So many times people have been told they are not worthy, and I, like many other treatment providers, am here to tell them that they are worthy.”

How Our Providers Inspire Hope

Given the importance of hope during recovery, part of our job as care providers is to inspire this hope when our consumers may be struggling to find it on their own. The process of inspiring hope may look different from provider to provider and consumer to consumer, but generally speaking, it involves a combination of validation and encouragement.

“My work helps consumers believe they can get better because throughout the intake process, I validate the person and their experiences while also providing encouragement to them that things can get better and that they deserve good things in life,” Christine explains. She also offers an example of one time she did this for a consumer:

“One time when I helped a consumer find hope of recovery was when I was doing an intake with someone who was struggling with depression, anxiety, severe trauma, and substance use. She cried so much, as telling her story was very hard. She told me that she had put off the intake for a while. I was able to remind her of her incredible strengths as well as how excited I was for her to be getting into services. She told me how much she appreciated being heard and was now eager to start in services.”

Molly also focuses on praising consumers for their personal strengths. “I help them see the strengths they already possess to help them continue to fight for recovery,” she says. “I like to highlight that they are the experts in their own life and they have the ability to fight for an improved quality of life.” Molly also shares a story about how she has accomplished this:

“Before becoming a wraparound facilitator and intern, I worked as a DCS life skills specialist and provided skills training and supervised visitation for families. I always tried to help my families feel empowered and capable of making the positive changes needed to reunite with their children. I always felt like they needed someone to believe in them as a person and a parent to help them overcome their obstacles in life.”

When providers are able to help their consumers find hope, the results can be remarkable, as MeLinda shares through another story: “I remember a client who came to work with me and was so used to others not believing in them that they attended our first few sessions without speaking more than a few words, their head dropped, and very little eye contact. Their world had become so small and their hope had become invisible,” she says. “During our time together, this person was able to have stronger relationships with their children, increased desire to pursue their passions, and would come to my office open and excited to set goals. Hope is hard to define, but you know it when you see it and when you feel it.”

Jenna shares the following perspective in summary: “Every day and every conversation I’m having with the consumers and families I work with is planting seeds, and watering and caring for those seeds after they’ve been planted. That’s all I think any of us in the helping field are doing. I’ve had lots of consumers find hope for recovery, but often when they are telling me about it, I can think of many other people that have been lifting that person up at the same time.”

Hope is a powerful force. It gives us motivation when we are feeling defeated. It presents us with an image of what our lives could look like in the future. And it pushes us to become our best and most authentic selves. Hope is absolutely essential for any person in recovery from a behavioral health challenge, which is why we strive to nurture it in every individual we work with.

Thank you to Jenna Batta, Molly Pennell, Christine Watson and MeLinda Frazee for sharing their beliefs and insights about the hope of recovery. It’s because of your passion and commitment that we can bring new hope to the people we serve!

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If you enjoyed this blog post about the hope of recovery at Cummins, then you might enjoy reading about our other organizational values below!

cummins-values-respect
Why Respect Is at the Core of Our Work
cummins-values-continuous-learning
How We Practice Continuous Learning Every Day