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'Handle with Care'. Working 'Wisely' with the Shamed Client

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'Handle with Care'. Working 'Wisely' with the Shamed Client Fall 08 February 2019 201820182018 ‘Handle with Care’. Working ‘wisely’ with the shamed client: An evidence-based exploration of the transformation of meaning. Jessica Haskins A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of the Professional Doctorate in Counselling Psychology. Word Count: 34,253 University of the West of England Department of Psychology Faculty of Health and Life Sciences. i Abstract Toxic shame is experienced as an extremely painful affective state where both external and internal worlds are seen as persecutory, and this drives many other emotional experiences and can hinder therapeutic growth. This thesis is a scoping study that considers how toxic shame experiences might be transformed in therapy through using ‘wise’ interventions, an exciting development borne out of social psychological research (Walton, 2014). Wise interventions work on underlying psychological processes to change the meaning of subjective experiences. Two rapid evidence assessments were conducted; one to explore how shame is experienced between therapist and client, and the second on what works in reducing toxic shame in therapy. These findings were synthesised to inform creation of a range of intervention techniques based on ‘wise’ principles, which were refined through consultation with five counselling psychologists in training. Seven themes were produced from the experiential review, covering aspects such as identity, fear, and relational ruptures. The review on shame reduction found limited evidence of impact, but provided a range of therapeutic modalities from which to draw strategies. Consultees noted that the research brought insight in to experiences that might be tapping in to shame, and welcomed ‘wise’ strategies that might help alleviate and transform clients’ toxic experiences. The thesis provides a tentative first step in producing wise interventions that would benefit from further, broader consultation, and testing in therapeutic settings. They provide a novel way of thinking about, and working with, shame, especially in pluralistic/integrative therapy. The principle driven nature of interventions means that they may have wide applicability given that the shame experiences discussed can occur in a broad range of contexts and may underpin a range of psychological problems, impacting on the efficacy of therapy. Further implications and caveats around wise interventions in relation to counselling psychology are discussed. i Acknowledgements This thesis is dedicated to my children, Rafael and Zola. You give me strength every day, courage in my convictions, and happiness and joy in my life. All I do is for you. The creation of this thesis has been a huge endeavour, both personally and professionally, but I would not have got to where I am now without all the support I have had around me. For all those that have been there for me in some way, no matter how small, never underestimate what your encouragement has meant to me. It would be impossible to name everyone who has touched me, but just know that a part of each and every one of you is somehow bound up in this writing. I have changed hugely throughout my doctoral training, and that process is reflected in this thesis. I now have new identities as both a counselling psychologist and a mother, neither of which I could claim at the start of this journey. I have learnt to accept and tolerate my failings, and not to be afraid to share myself, academically and personally. Thank you to all of those who have helped me to achieve this, and stuck with me even in the toughest of times, through my stubbornness and through times when I have felt too wounded to continue. Thank you to my parents, Anna and John, who have been there every step of the way, in so many ways. Your unwavering belief in me has carried me through so many tough times. Mum, you have provided me with the secure base that I needed to have the strength to face my shame. John, I am so lucky to have had a second chance at having a Dad. You didn’t have to be there for me but you chose to be, and that speaks volumes. Not to mention your courageous effort to read a draft of this thesis! So many family and friends have been part of this – Tam you have provided a listening ear on many occasions; Polly thank you for reading a draft and for the counsellors’ ear you provided when I was dealing with my own shame; Tim, thank you for also offering to read my draft; Grandma and Aunt Penelope thank you for always asking how it was going and spurring me on. I am sure Grandpa will be smiling down right now! Dear Rory, you have been through all the highs and lows, and always believed in me. Thank you, a hundred times over. Not only that but you have had to be the single parent many weekends whilst I worked on this project. To my wonderful children, Rafa and Zola; you have brought me great joy and a new aspect to my identity, which I believe has helped me to heal. You keep me grounded and offer a perfect antidote to the stress of writing, by reminding me to live in the moment and be a kid again with you. Of course I cannot forget the other member of my family, Pickle, my dog. Thank you for all the countless hours you have sat beside me in my office as I have written, or stared, or sat with head in hands. A ii quiet but loving support, who has clambered in to my lap for a hug whenever I have needed it most. Lastly, I am indebted to the University of the West of England, who have supported me through the difficult journey of doctorate and thesis. I have learnt so much in the past six years, which I hope I will take in to all that I continue to do. Special thanks goes to those who took part in the consultation for your wise words and general enthusiasm! Thank you to my supervisors. Liz, you have provided reassurance when I needed it. But Miltos, it is you that I am so very grateful to. You have been with me on this journey. Through the tears and the worry you have always believed in me. Even when you found it hard to see where I was going with this work, you kept the faith. Thank you. To all those that told me I was undertaking too much with this thesis; you were right. But I got there, eventually. iii Table of Contents Abstract ................................................................................................................. i Acknowledgements .............................................................................................. ii 1 Literature Review/ Background ...................................................................... 1 1.1 Opening reflections on shame and orientation to the research ................................... 2 1.2 Defining shame .............................................................................................................. 3 1.3 Shame as a social emotion ............................................................................................ 4 1.4 Shame, attachment and achieving relational depth ..................................................... 6 1.5 Shame and different problem dimensions .................................................................... 9 1.6 Working with shame ................................................................................................... 11 1.7 Wise methods .............................................................................................................. 13 1.8 Rationale ...................................................................................................................... 23 1.9 Aim ............................................................................................................................... 24 2 Methodology ............................................................................................... 26 2.1 Epistemological assumptions ...................................................................................... 26 2.2 Methodological approach ........................................................................................... 27 ................................................................................................................................................. 28 ................................................................................................................................................. 28 2.3 Parts 1 and 2: Rapid Evidence Assessments ................................................................ 29 2.4 Part 1: REA 1. How is shame experienced in the therapy room? ................................ 29 2.5 Part 2: REA 2. What works in reducing (or increasing tolerance to) shame in individual therapy? .................................................................................................................................. 36 2.6 Part 3: Synthesis. What might Wise interventions for working with shame look like? 40 2.7 Part 4: Consultation. Do practitioners see value in using therapeutic strategies as Wise interventions to transform shame-based experiences? ................................................ 40 3 Findings ....................................................................................................... 43 3.1 Part 1. How is shame experienced in the therapy room? ........................................... 43 3.1.1 Finding the toxic part(s) of me ............................................................................. 45 3.1.2 Your shame is my shame. The relational experience ........................................... 49
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