TIFT #133: Why Shame and Low Self-Esteem Resist Change

Here’s the answer: self-judgments have to be made in relation to standards. Those are internalized values, attitudes, ideals, and prohibitions. They are an essential component of the conscience, and their purpose is to keep our behavior in line with family or group expectations using shame and pride as reinforcers. Imagine if those standards could easily be changed (corrupted) on a whim? The functioning of the conscience depends on the integrity of its standards, especially when we are in the grip of temptation. Of necessity, the mind works very hard to keep those standards from being weakened or altered, even when they are unhealthy.

Why do humans have a conscience?

In “lower” mammals, survival has always depended mostly on fight, flight, and freeze. Those strategies are quite effective because the job of selecting the right response for a given situation is easy to make. “How big and menacing is the predator?” “What are my chances?" Mammals also organize themselves socially, but this, too, is relatively simple. Discipline is maintained through hierarchy and dominance. The alpha animal keeps the others in line.

When humans evolved, the task of survival changed radically. Our survival as a species came to depend on complex social structures and their maintenance. Furthermore, the slow development of human young adds complexity. Responsibility for discipline shifts mid-development from the nuclear family to the tribe. Another example of the complexity with which we still have trouble is in how we treat insiders and outsiders. One group gets our empathy and allegiance, while members of the other are treated with suspicion, but who belongs to which group is not always clear. In the modern world, deciding whom to trust has become difficult and contentious. We need a system capable of handling social subtleties far more complex than other mammals. That’s one powerful reason why evolution has provided us with consciousness and reasoning. It is also a reason for the development of a self-contained behavior regulating system.

How does the conscience work?

Instead of placing the full responsibility for maintaining social cohesion on a dominant member, humans have an internal control system located in each individual. The conscience is analogous to societal justice systems. In fact, it is likely that police and court systems have been modeled on individual psychology. In the individual conscience, culture is the equivalent of the legislature, the main source of the standards internalized in each individual brain. These standards function like laws and law books. The cortex provides the court of law where judgments are made, and the “enforcement arm” of the system utilizes pride, shame, and guilt to punish wrongdoing and reward the righteous.

While pride, shame, and guilt originate in the cortex, their emotional power suggests that their content is passed down to a subcortical, “limbic” level. The function of social discipline, handled in lower mammals through the neurophysiology of dominance and submission, becomes the source of pride and shame in humans (Maibom, 2010). For example, the feeling and even body postures represented by the phrase, “hang your head in shame,” have been traced to brain areas related to submission while pride is analogous to dominance.

How are standards internalized?

My (2004) paper on therapeutic action through the lens of trauma described a functional view of the conscience or superego as a regulator of behavior and source of pride, shame, and guilt. Influenced by Conway and Seigelman’s book, Snapping (1995) I noted how internalization of standards can be  sudden and involuntary, as in trauma and brain washing or gradual and voluntary as in toilet training. In the case of trauma, the perpetrator’s negative attitudes towards the self are internalized and become the basis of self-loathing, low self-esteem, and shame. I concluded then that the trigger for internalization of either kind was attachment anxiety, the wish to ensure connection. In trauma, I hypothesized that the sense of aloneness and vulnerability associated with being under personal attack lead naturally to identification with the aggressor and internalization of the perpetrator’s negative and devaluing attitudes towards the self.

Unhealthy standards can be internalized

Where Freud’s conceptualization of superego development ended with relinquishment of competitive desires in relation to the father, an important observation from trauma is that internalization of standards can continue even into adulthood and is an important part of what is now thought of as complex trauma. These later additions to the person’s collection of internalized standards are often pathological and become the roots of the inappropriate shame and guilt that are so prevalent as consequences of being hurt by a powerful and devaluing other.

Clients, and most of us for that matter, make the automatic assumption that our conscience could only represent the “good.” In fact, distorted standards are one of the most common sources of pain and suffering, whether from negative parental attitudes or from various forms of trauma. Realizing that their conscience can be wrong is unnatural for clients and often represents the first challenge in clinical work. Clients’ usual response to having their standards questioned is to rationalize their low self-esteem, arguing that the standards are correct. In the next section we’ll see why.

Why is change hard?

Margaret, about whom I have written before, had been terrorized by her overcritical alcoholic father’s devaluing judgments. Her fear was of being banished from the family if she showed any spunk or assertiveness. In therapy, when her fear was activated and, at the same time, the love and respect she received from her current family was disconfirming her inner attitude, the requirements for memory reconsolidation were fulfilled and her inner schemas were rewritten such that her fear of banishment was permanently resolved.

As often happens, even after that transformative change, she has continued to struggle with inappropriate shame. The trouble is in another layer of EMP, a conscience layer. Fear causes anxiety, but pathology of the conscience causes shame. Every time she moves towards coming out of her shell, she experiences a wave of shame and self-criticism. This “backlash” is the indicator that her conscience is still doing what it is supposed to do, discouraging her from defying the self-devaluing attitudes internalized from her father. Her belief that self-promotion would lead to banishment is gone but still intact is her internalized sense that she must never feel good about herself. As we have worked with her shame, it is clear that this was not going to be as easy to change as the fear of banishment.

As I indicated at the beginning of this post, for the conscience to do its job, the standards it uses have to be highly resistant to “corruption.” My 2004 article described this difficulty and raised a question about why. Is it something inherently different about internalized standards, or are they simply guarded more avidly than other mental contents. 

Working with another client made the answer clear. As reported in TIFT #98, it only took a few examples of rapid, enduring change to shame-generating values to show that the reason for their persistence was not something unusual about internalized standards, but the energy and persistence with which the mind guards their contents. Carole, who had been heavily traumatized in childhood and made to feel ashamed of having been a victim of sexual abuse at age five, suddenly realized that when the sexual abuse happened she was too young to experience shame. It had been physically painful but, for her, it carried no shame. The bad feeling that had haunted her for a lifetime came entirely from her mother. It was instantly obvious to her that the shame was not hers and it disappeared on the spot. The strong presence of disconfirming information allowed memory reconsolidation to do its work of enduring change.

How does the mind resist change in standards?

Margaret did not have Carole's clarity. It was much harder for her to keep in mind that her shame was ill founded. She had given her conscience a name, Penelope, the faithful guardian of what is “right.” In fact Penelope was not at all right, and was, in fact, destroying Margaret’s happiness. How did her inner mind resist change to her unhealthy standards? It’s tactics were mainly aimed at preventing disconfirming information from being delivered to the places in her brain where the old standards were lodged.

• In spite of learning that her shame was unwarranted, Margaret would, within hours or days, revert to the assumption that what felt shameful must be bad. 
• Her inner mind would somehow have her forget the conversation we had in therapy about how her self-defeating attitude came from her father, the least reliable source of wisdom about her personal value.
• When she had thoughts about doing something self-promoting, she would listen to prompts from her conscience and abandon her plans.
• She would regularly fail to do the homework I suggested for the time between sessions. 
• Even when she did engage in “civil disobedience,” acting against her values, the resulting shame made her devalue and discount her own success.

All these tactics made sure she would not experience the thrill of exciting activities and experiences to contradict her poor self-esteem. The shame-producing values were reinforced at every turn. The best we have been able to do is to chip away at her shame, allowing incremental change to erode her internal self-criticism.

How can a therapist help?

Engaging the client in working against their own conscience is one of the greatest challenges in doing psychotherapy. The first goal is to help the client become perfectly clear that they are carrying an internalized standard that came from a negative source and is not healthy, wise, or in their own best interests.

Next I begin to promote the idea of “civil disobedience,” meaning doing the opposite of what the unhealthy standard wants. While words are not very effective at delivering a nonverbal, disconfirming message to the inner mind, experience is closer to the language of the inner mind. The experience of acting in ways that are clearly contrary to the unhealthy internal value and realizing that nothing bad has come of it is a powerful way to initiate memory reconsolidation through disconfirming information.

While these two strategies are the mainstay of treatment, this is a place where persistence, a strongly positive therapeutic relationship, and holding the client accountable (without shaming) are the best tools we have to support the kind of disconfirming experiences that show the inner mind the shame is not warranted.

What to watch out for

Doing this work brings up two very import caveats. The first one is that clients are strongly attached to their standards and have no idea that they might be anything but positive and true. A therapist who challenges the client’s standards can easily be misperceived as trying to corrupt the client. This can lead to major ruptures in the alliance. We need to tread lightly and carefully in undertaking the task of questioning anyone’s values, even when it is obvious to us that they are pathological.

Assuming we have achieved goal alignment around changing values, there is yet another problem that can disrupt the therapy. “Civil disobedience,” especially at first, should be expected to bring with it a shower of shame and doubt. Forewarning the client is exceedingly important. The shame they experience is simply an indication that the conscience is doing its job of following internalized standards and heaping shame on the client for violating them. Without being warned, the client will think they have done something terrible that they should never try again.

The homework my clients should, but often don’t do:

I often suggest a spiral-bound blank book, where the client is instructed on the left to give a non-judgmental, respectful representation of the (pathological) thinking and wishes of the inner self. On the right, they are told to represent the contrasting, healthy adult point of view.

Doing this accomplishes several things. Using accurate empathy to represent the point of view of the inner self helps open up channels for dialogue with the inner mind. This can range from giving the client a sense of the therapist’s real interest and desire for understanding, all the way to awakening a dissociated inner self and initiating a dialogue. In contrast, the right side of the blank book is devoted to a mindful point of view, a larger and more accepting perspective. This promotes disconfirming messages while the left side of the page has already helped to open up of a communication channel to the inner mind.

The spiral-bound book also works against another very common tendency of the mind, to rationalize contradictory views with a compromise. “Well, I don’t believe in self-promotion, but maybe a little is OK.” This tends to mask the binary thinking that is causing the trouble, while giving permission to accept and adopt relatively unhealthy behavior. It is one of the inner mind’s best techniques for preventing therapy from having a real impact. Soon the lessons of the therapy are blunted and the client can go back to “normal.”

Clients often do resist the spiral-bound book. I suppose that’s precisely because it is effective in leading to disconfirming experiences. When clients are able to adopt it, it can be of significant help in maintaining some pressure on the inner mind between sessions, a time when resistance so often counteracts what progress was generated in session.

References

Conway, F., & Siegelman, J. (1995). Snapping: America's epidemic of sudden personality change (2nd ed.). Stillpoint Press. 

 Maibom, H. (2010). The Descent of Shame. Philosophy and Phenomenological Research, 80, 566-594. https://doi.org/10.1111/j.1933-1592.2010.00341.x. 

Smith, J. (2004). Reexamining psychotherapeutic action through the lens of trauma.. The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 32 4, 613-31 . https://doi.org/10.1521/jaap.32.4.613.53839.

Jeffery Smith MD

Photo Credit:  Eugene Chrystiakov, Unsplash