Skip to content

How Healing From Shame Can Help You Manage Depression

healing from shame can help you manage depression

It’s Not Always Depression.
Sometimes it’s shame.
Written by: Hilary Jacobs Hendel, LCSW, author of It’s Not Always Depression

How can it be that a seemingly depressed person, one who shows clinical symptoms, doesn’t respond to antidepressants or psychotherapy? Perhaps because the root of his anguish is something else.

Several years ago a patient named Brian was referred to me. He had suffered for years from an intractable depression for which he had been hospitalized. He had been through cognitive behavioral therapy, psychoanalytic psychotherapy, supportive therapy, and dialectical behavioral therapy. He had tried several medication “cocktails,” each with a litany of side effects that made them virtually intolerable. They had been ineffective anyway. The next step was electroshock therapy, which Brian did not want.

When he first came to see me, Brian was practically in a comatose state. He could barely bring himself to speak, and his voice, when I managed to get anything out of him, was meek. His body was rigid, his facial expression blank. He couldn’t look me in the eye. Yes, he seemed extremely depressed. But knowing he had been treated for depression for years without good results, I wondered about the diagnosis.

Even though we were together in my office, I was struck by a strong sense that Brian was elsewhere. I asked him what percentage of him was with me in the room.

“Maybe 25 percent,” he said.

“Where is the rest of you?” I asked.

“I don’t know,” he said, “but someplace where it is dark and I am alone.”

“Would you like me to help you get you a little more relaxed?” I asked.

He looked a bit surprised but said yes, so I grabbed a small cushion off my sofa and tossed it to him. He caught it and smiled.

“Toss it back,” I playfully commanded. And he did. His body loosened perceptibly and we talked some more. When I asked, after several minutes of tossing the cushion back and forth, what percentage of him was now with me, he responded with another smile. “I am all here now,” he said.

That’s how it went for several months: We played catch while we talked. Playing catch got him moving, relaxed him, established a connection between us—and was fun.

During our initial sessions, I developed a sense of what it was like to grow up in Brian’s home. Based on what he told me, I decided to treat him as a survivor of childhood neglect—a form of trauma. Even when two parents live under the same roof and provide the basics of care like food, shelter, and physical safety, as Brian’s parents had, the child can be neglected if the parents do not bond emotionally with him.

This I suspected was the case with Brian. He told me that his parents were both “preoccupied” with the heavy burdens of a family that “could barely make ends meet.” While his mother never called herself an alcoholic, she drank to excess, and his father was often emotionally checked out as well. Brian had few memories of being held, comforted, played with, or asked how we was doing.

Related: 4 Parenting Behaviors That Damage A Child’s Self-Esteem

Chronic Shame Affects Emotional Expression

One innate response to this type of environment is for the child to develop chronic shame. He interprets his distress, which is caused by his emotional aloneness, as a personal flaw. He blames himself for what he is feeling and concludes that there must be something wrong with him. This all happens unconsciously. For the child, shaming himself is less terrifying than accepting that his caregivers can’t be counted on for comfort or connection.

To understand Brian’s type of shame, it helps to know that there are basically two categories of emotions.

understanding emotions

There are core emotions, like anger, joy, and sadness, which when experienced viscerally lead to a sense of relief and clarity (even if they are initially unpleasant). And there are inhibitory emotions, like shame, guilt, and anxiety, which serve to block you from experiencing core emotions.

Not all inhibition is bad, of course. But in the case of chronic shame like Brian’s, the child’s emotional expression becomes impaired. Children with too much shame grow up to be adults who can no longer sense their inner experiences. They learn not to feel, and they lose the ability to use their emotions as a compass for living. Somehow they need to recover themselves.

Accelerated Experiential Dynamic Psychotherapy

I specialize in something called accelerated experiential dynamic psychotherapy (AEDP). After being trained as a psychoanalyst, I switched to this approach because it seemed to heal patients who hadn’t gotten relief after years of traditional talk therapy.

Many psychotherapies focus on the content of the stories that people tell about themselves, looking for insights that can be used to fix what’s wrong. By contrast, AEDP focuses on fostering awareness of the emotional life of the patient as it unfolds in real-time in front of the therapist. The therapist is actively affirming, emotionally engaged and supportive. She encourages the patient to attend not only to his thoughts and emotions but also to the physical experience of those thoughts and emotions.

Related: What To Do If You Are Depressed: A 15-Step Guide

In the first year of our work together, during almost every session, Brian would plummet into states that I can describe only as wordless suffering. I tried during those fugues to bring him back to the present moment with firm commands. “Plant your feet on the floor,” I’d say. “Press your feet against the ground and sense the earth underneath you.”

Sometimes I asked him to name three colors in my office or three sounds he could hear. Sometimes he was too emotionally out of reach to comply. In those instances, I just sat with him in his distress and let him know that I was there with him and wasn’t going anywhere.

In Brian’s second year of treatment, he became more stable. This allowed us to work with his emotions. When I noticed tears in his eyes, for example, I would encourage him to inhabit a stance of curiosity and openness to whatever he was feeling.

This is how a person reacquaints himself with his feelings: to name them; to learn how they feel in his body; to sense what response the feeling is calling for; and in the case of grief like Brian’s, to learn to let himself cry until the crying stops naturally (which it will, contrary to a belief common among traumatized people) and he feels a sense of visceral relief.

Brian and I worked together twice a week for four years. One by one, he learned to name his feelings and to listen to them with care and compassion. When he did feel the urge to “squash himself down,” he knew what was happening and how to manage the experience. He learned to express his feelings and assert his needs and wants. He took risks, made more friends, and engaged in meaningful work. There were no more hospitalizations. His shame dissipated. Most important, he felt alive again.

Please share this article with anyone who you may think will find it valuable and helpful.


Originally appeared on: Psychology Today
Republished with permission
healing from shame can help you manage depression pin

Hilary Jacobs Hendel

Hilary is the author of the award-winning book, It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self (Random House & Penguin UK, 2018). She received her BA in biochemistry from Wesleyan University and an MSW from Fordham University. She is a certified psychoanalyst and AEDP psychotherapist and supervisor. She has published articles in The New York Times, Time, NBC, FIX, Oprah, and her blog is read worldwide.View Author posts

Leave a Reply

Up Next

What Exactly Is Emotional Exhaustion? 8 Signs You Really Need A Break

What Exactly Emotional Exhaustion

Sometimes life can be tiresome - one minute you’re up and the next second, you’re back down. Emotional exhaustion is when emotions become “too much” and you feel drained.

However we experience stress and fatigue almost every day, so what makes this condition different from the daily stress of life? Let’s take a look at emotional exhaustion vs burnout, the signs, and how to deal with it.

What is Emotional Exhaustion?

It is a chronic state of physical and emotional depletion with a feeling of being emotionally overextended and can arise when someone experiences a period of excessive stress in their work or personal life. This can impact a person’s everyday life, relationships, and behavior.

Up Next

Sohwakhaeng: The Korean Philosophy Of Small But Certain Happiness

Sohwakhaeng

Are you struggling to find happiness? Is your desire to find happiness making you frustrated? Are your unrealistic goals making you miserable? Then it is time for you to practice the Korean philosophy of Sohwakhaeng - small but certain happiness.

Spreading like wildfire in social media, Sohwakhaeng (소확행) is an online trend among Korean youth and has quickly become the preferred lifestyle among people tired of pursuing traditional “success” and “happiness”. Rather than being obsessed with finding happiness through their career, relationships or materialistic possessions, Korean youths are seeking happiness in little things. But what are these little things that make this Korean philosophy so unique and special? Let’s explore. 

Up Next

10 Gratitude Exercises: Fun Ways Of Practicing Gratitude With Your Family This Thanksgiving

Gratitude Exercises

Thanksgiving is a great time to be thankful for all the blessings we have in our life. But it shouldn’t be the only time when we are grateful. Practicing gratitude can make your thanksgiving even better. Here are some gratitude exercises to truly celebrate the things you are thankful for.

Thanksgiving: A day to be thankful

Thanksgiving is a holiday that reminds us to be grateful and thankful for what we have in our lives - our family, loved ones, career, health, passions and mental wellbeing. No wonder, most of us feel a sense of togetherness, closeness and warmth during this holiday as practicing gratitude can result in various positive feelings. 

Do you know about the history of thanksgiving? Thanksgiving was

Up Next

Marasmus: How A Lack Of Affection In Early Childhood Affects A Child

Marasmus Lack Of Affection In Early Childhood

When it comes to having a happy and healthy childhood, attachment and affection are extremely important and even non-negotiable. So, a lack of affection in childhood can determine to a huge extent, your mental health and psychological well-being when you finally enter adulthood, and this is where the concept of marasmus comes in.

When a child is separated from their primary attachment figures, (namely the mother), it can lead to devastating psychological consequences, which end up affecting their entire lives. It might even lead to death sometimes. The kind of affection and attachment a child is subjected to from their family and the environment they grow up in decides how they see and perceive the world when they become adults.

British psychologist, John Bowlby studied how the mother-baby bond is formed, and American-Canadian psychologist, Mary A

Up Next

High-functioning Depression: 7 Signs you are suffering in silence

High Functioning Depression Signs

You are “employee of the month” for the third time in a row. Your house is clean and organized. Your bills are paid. You are a responsible & loving partner and parent. You go to the gym and stay healthy. You volunteer to give back to your community. 

People feel inspired by you. 

But when all's said and done, when no one is watching, your depression sinks in. You feel like you are always exhausted, unhappy and empty inside. 

But why would you be so depressed when you have everything you need? What could you be depressed about when you have achieved everything you set out to achieve?

When it comes to depression, you don't necessarily need a reason for how you feel.

Depressio