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Thursday, March 29, 2018

How Your Fear and Shame Can Lead to Avoidance in Therapy

When clients come to see me for an initial consultation in my psychotherapy private practice in New York City, I usually suggest that they give me a general idea of their presenting problem during that first session rather than getting into a lot of detail.  One important reason for that is that most people feel emotionally vulnerable during the consultation, and it can feel too exposing to them to get into a lot of details about their problems.  During that initial consultation, it's important for the client to see if she feels comfortable enough with me before she spends time revealing the depths of her problems, which could be shame inducing and anxiety provoking in the first session.

How Your Fear and Shame Can Lead to Avoidance in Therapy

If a client feels comfortable enough with me to come to subsequent therapy sessions, he can reveal more about himself.  For someone who feels ashamed of his problems, he can gradually reveal the areas of his life that might be causing him to feel ashamed.

As the client and I develop a more trusting therapeutic alliance, the problems that are creating shame for him usually emerge.  By then, the client has a sense that I've heard a lot as a psychotherapist of 20+ years and that it's unlikely he will bring up something that I haven't already heard about and helped other clients to overcome.

As the therapeutic alliance gets stronger and trust increases, a client usually feels more comfortable allowing himself to be more emotionally vulnerable with me.

But there are some clients who avoid talking to their psychotherapist about issues that they feel ashamed about even after they've been in therapy for a while and trust their therapist about most other issues.

Some of these clients unconsciously project their own negative feelings about themselves onto their therapist.  So, for instance, a client might blame himself and consider himself to be "a bad person" because he was sexually abused by a relative when he was a child (or for some other problem).  Rather than recognizing that he is the one who thinks he is "bad," he projects these disowned feelings about himself onto the therapist and tells himself that the therapist is the one who would think he was a "bad person" if he divulged the sexual abuse (see my article: Overcoming the Psychological Effects of Childhood Sexual Abuse).

It's unfortunate that there are clients who can go through an entire course of psychotherapy and never reveal certain things that cause them to feel ashamed.  In these cases, I'm not talking about things that  clients don't remember, which they can't bring up because they aren't consciously aware of these issues.  I'm referring to unresolved problems that they do remember.  These clients make an ambivalent decision not to talk to their therapist about these issues.  As a result, the therapy remains incomplete and the client doesn't get the help that he needs for this area of his life.

Fictional Clinical Vignette: How Your Fear and Shame Can Lead to Avoidance in Therapy 
The following fictional clinical vignette illustrates how fear and shame can be a hindrance with regard to addressing certain topics in therapy, and how a psychotherapist can address these issues in therapy:

Becky
Becky, a woman in her early 30s, began therapy to deal with anxiety that was affecting her in her personal life as well as in her career.

Prior to starting psychotherapy, Becky talked to her primary care doctor about getting a prescription for anti-anxiety medication.  Her doctor advised her to seek help in psychotherapy because he was concerned that, even though the medication would work to alleviate the medication, Becky would be reliant on the medication rather than learning coping strategies to alleviate the anxiety.  He also advised her that the medication could have side effects for her.  So, instead of prescribing medication, he referred her for psychotherapy (see my article: Medication Alone Isn't As Effective As Psychotherapy to Overcome Anxiety and Depression).

During the initial stage of psychotherapy, Becky focused on the anxiety she experienced in her dating life and at work.  Her psychotherapist taught Becky coping strategies that helped to alleviate the anxiety at work, but Becky continued to feel anxious when she went out on dates.

Becky told her therapist that even when she really liked a man that she dated a few times, she felt too anxious to continue seeing him.  She would usually make some excuse to discontinue seeing him.  Then, afterwards, she would feel frustrated and sad because she felt that she might never get into a serious relationship if she continued to allow her anxiety to cut short any possibilities with the men that she met and liked.

She explained to her psychotherapist that there was a part of her that very much wanted to be in serious relationship and eventually get married and have children.  But her anxiety about getting closer to a man outweighed her desire to be in a serious relationship, and made it impossible for her to develop a relationship.

She had never been in a serious relationship before.  All of her prior relationships with men were superficial.  Her fear was that if she continued to end things before she could develop a relationship, she would be alone and lonely.

During the initial stage of psychotherapy, when her psychotherapist asked Becky questions about her childhood history, Becky denied that she had ever been abused in any way.  But, as the therapy progressed, Becky became increasingly uncomfortable because she knew that she wasn't being forthcoming about her history of sexual abuse.

Even though she didn't tell her psychotherapist about it, Becky remembered all too well that when she was five years old, she told her mother that her maternal uncle was sexually molesting her.  At first, her mother didn't believe her.  She accused Becky of making up lies and punished her.  But then one day, when her mother left Becky in the care of the maternal uncle, her mother came home to find the uncle in Becky's bedroom on top of Becky on the bed.

Her mother was very upset and threw the maternal uncle out of the house.  She took Becky to the pediatrician and told him what she witnessed when she came home.  After examining Becky, the pediatrician told the mother that there were no signs of penetration.  Then, the pediatrician called the bureau of child welfare to report the case.  The pediatrician also recommended that the mother take Becky for counseling, which her mother never did.

After the doctor's visit, her mother told her that she was "evil" for allowing the uncle to molest her.  She said that Becky must have "seduced" the uncle and he wasn't to blame for what happened.  Instead, she placed the entire blame for what happened on Becky, who believed her mother and felt deeply ashamed.

Her mother also warned Becky that if Becky told the social worker from the bureau of child welfare what happened, she would be taken away and placed in foster care.  This frightened Becky more than anything, so when the social worker interviewed Becky, she told her that she made up the story about the sexual abuse.  Becky's mother also denied seeing anything when she came home.

After that, Becky's mother told her that she should never tell anyone about this or she would be taken away from their home.  Her mother also told her that they would never discuss it again (see my article: Breaking the Family Code of Silence in a Dysfunctional Family).

In the meantime, the mother didn't allow the uncle to come to the house anymore, but the mother didn't tell other family members what happened because she was ashamed that Becky "allowed" the sexual abuse.

As a result, Becky had to be around her maternal uncle at family gatherings where he would sometimes touch her inappropriately when no one was looking.  He told her that she should never tell anyone about it, and she didn't because she believed it was her fault.

Her psychotherapist, who had dealt with many clients who had unresolved childhood trauma, sensed that Becky was avoiding talking about childhood trauma.  She didn't want to push Becky to talk about it before Becky was ready, but she also knew that if Becky continued to avoid talking about any possible abuse, this would be an obstacle to Becky making progress in therapy.

One day, when her psychotherapist sensed that Becky was opening up more and she might be receptive, the psychotherapist told Becky that she had a sense that there might be something that Becky was avoiding discussing in therapy that might be related to her discomfort with men.  She said this in a empathic and tactful way to give Becky a chance to open up.

How Your Fear and Shame Can Lead to Avoidance in Therapy
At first, Becky hesitated and then she burst into tears.  After she calmed down, she admitted to her therapist that she was, in fact, holding something back because she felt so ashamed.  But, she said, she wanted to  begin talking about it because she felt it was related to her fear of getting closer to men.

Then, she told her psychotherapist what happened to her when her maternal uncle sexually abused her from the ages of 5-12, how her mother blamed her when she initially found out about the early abuse and didn't protect her when they were at family gatherings, and how she felt too ashamed to ever tell anyone about the abuse again, which continued for several years.

She also told her therapist that, as an adult, she knew objectively that she wasn't to blame for the abuse but, on an emotional level, she still blamed herself.

Once she revealed the abuse to her psychotherapist, she felt somewhat ashamed but she mostly felt relieved not to be holding onto this secret anymore.  They were able to talk about how fearful Becky felt about revealing the abuse to her psychotherapist.

She said that, even though she realized objectively that her psychotherapist had dealt with many clients who had been sexually abused and that her therapist wouldn't blame her for it, Becky still felt on an emotional level that her therapist might see her as being "evil," like her mother did.

The more Becky was able to talk about the sexual abuse with her psychotherapist, the freer and less ashamed she felt.  Eventually, they used EMDR therapy to help Becky overcome the trauma of the childhood abuse (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

As they worked on helping Becky to overcome the trauma with EMDR therapy, Becky began to feel more comfortable with men.

When she met a man that she really liked, she continued to date him to get to know him.  When she was ready to be sexual with him, she told him, somewhat shyly, that she had never been sexual with a man before.  She was afraid that he would laugh at her or think she was strange but, instead, he was understanding and patient with her, and their relationship eventually flourished.

Conclusion
During the initial stage of psychotherapy, it's common for clients to hesitate about revealing certain aspects of their lives, especially problems that cause them to feel emotionally vulnerable and ashamed.

The problem arises over time when clients avoid talking issues that are related to the presenting problem because they feel too ashamed to talk about it.  This hinders the therapy because the therapist isn't getting the full picture and, if clients continue to avoid talking about what they feel ashamed about, they don't overcome their shame.

When they're ready to talk about it, most people usually feel relieved after they've divulged what they've been avoiding.

Clients in therapy will often say that, after they reveal what they've been avoiding--whether it has to do with sexual abuse, problem drinking, body image problems or whatever the issue is, they feel a huge burden as been lifted from them.  Then, they and their psychotherapist can work directly on resolving the problem.

Getting Help in Therapy
Struggling on your own with unresolved problems can be frustrating and upsetting (see my article: The Benefits of Psychotherapy).

Developing a trusting relationship with a psychotherapist can take time, but once you develop a trusting relationship, a skilled psychotherapist can help you to overcome problems that are keeping you stuck, so you can live a more fulfilling life (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, you owe it to yourself to get help.

Once you're in therapy, even if you're not ready to completely open up about what's making you feel ashamed, it's important to talk to your psychotherapist to let her know that there's something you feel ashamed about that you're not revealing.  Then, at least, your psychotherapist will be aware that you're struggling with shame and that you need help to bring up whatever it is that you're avoiding.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome trauma.

To find out more about me, visit my website: Josephine Ferraro, LCSW -NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


























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