Shame is a ubiquitous feeling that impacts all of us, is highly prevalent in therapy work, and yet little was known or discussed about it until a few decades ago. Ahead of our workshop with Lisa Etherson on understanding and working with shame through an attachment lens, which takes place on Friday 17th April via Zoom, we discuss what happens when shame comes to therapy.

Our upcoming BTP workshop on Shame: *Shame: Working Effectively with Shame in Therapy*, will take place on Friday 17th April, 10am-4pm, with catch-up recording available if you can’t make it on the day.

There is a particular quality to shame when it enters the therapy room.

It arrives quietly — sometimes hidden inside a story about something else entirely, sometimes announced in the way a client suddenly looks at the floor, or laughs too quickly, or trails off mid-sentence. As practitioners, most of us recognise it. That slight shift in the air. The sense that something tender and exposed is nearby, circling the edges of what can be said.

Shame is one of the most universal of human experiences, and yet it remains one of the least talked about — even in therapy, where the whole premise is that difficult things can be spoken. Understanding what shame is, how it operates, and how we as therapists can meet it with care and skill is among the most valuable work we can do.

Shame and Guilt: An Important Distinction

It helps to begin with a distinction that research and clinical experience both support: shame is not the same as guilt.

Guilt says, “I did something bad.” Shame says, “I am bad.” The difference matters enormously.

Guilt, though uncomfortable, is often workable — it is about a behaviour, and behaviour can be reflected on, changed, and repaired. Shame strikes at the core of identity. It is not about what I did; it is about who I am.

Brené Brown, whose work has brought shame into a much wider cultural understanding, describes it as the intensely painful feeling that we are unworthy of love and belonging. This speaks to the experience of shame involving a wish to hide, disappear, or sink through the floor. There is often a profound sense of exposure — as though some essential flaw has been seen.

Where Shame Comes From

Shame is a relational wound. It does not arise in isolation — it is born in the gaze of others, or in the imagined gaze of others. Developmentally, it often has roots in early experiences: being ridiculed, humiliated, or criticised by caregivers; receiving messages — spoken or unspoken — that one’s feelings, needs, or very self were too much, not enough, or fundamentally wrong. Many of the people we work with as therapists carry shame about things that were done to them, rather than things they did — abuse, neglect, poverty, mental illness in the family. Shame thrives in secrecy, and it grows more powerful when there is no one to share it with.

Cultural and social context matter too. Shame can attach to identity — to gender, sexuality, race, class, body, dis-ability. People may carry layers of shame that have been handed down through generations or imposed by systems of power. Being attuned to these wider dimensions is part of our work.

How Shame Presents in the Therapy Room

Because shame is so painful, it’s not usual for it to arrive directly in therapy. Instead, it tends to show up in disguise. For example, some people may present with anger or contempt — both of which can serve as protective defences against deeper shame.

They may minimise their experiences, dismiss their own pain, or deflect with humour. Or they may present as very compliant and eager to please, terrified of the therapist’s disapproval. Others may struggle to make eye contact or may find themselves unable to say certain things aloud, even things they have clearly thought about a great deal.

Dropping out of therapy — or not returning after a session where something vulnerable was disclosed — is one of shame’s most significant clinical presentations. When someone shares something that feels deeply exposing and then disappears, it is worth wondering whether they are managing an unbearable degree of post-session shame.

The Therapist’s Role: Witness, Not Rescuer

Perhaps the most important thing to understand about working with shame is this: shame heals in relationship. The antidote to shame is not insight, not reframing, not psychoeducation — though all of these have their place. The antidote is the experience of being truly seen and not turned away from.

When a client risks disclosing something they believe makes them fundamentally unlovable, and the therapist responds with steady warmth, genuine acceptance, and without flinching — something shifts. Sometimes something important shifts.

This does not mean we rush in to reassure or rescue. If we move too quickly to comfort we can inadvertently communicate that the feelings are too much to sit with — which reinforces shame rather than alleviating it. The therapeutic task is to remain present, to slow down, and to stay curious.

Naming shame carefully — and checking whether the word fits — can itself be a powerful intervention. Many people have never heard their experience named as shame, and the naming can bring both relief and recognition.

Attending to Ourselves

Working with shame needs us to be honest about our own relationship with it. Therapists are not immune to shame. We carry our own histories, our own sensitivities, our own fears of being exposed or found wanting. When a client’s shame touches our own, we can find ourselves moving away from the material, subtly changing the subject, or offering reassurance before it has been earned.

Supervision and personal therapy remain essential tools here —because the more we know our own shame, the less likely it is to drive our clinical decisions without our awareness.

We must also be aware that therapists can inadvertently induce shame in clients — through tone of voice, a poorly timed intervention, an expression that is misread, or a silence that feels like judgment rather than presence. If you sense a client has become shamed by something in the session, naming it directly and compassionately can be a moment of real repair.

A Final Thought

Shame tells people they are alone in their defectiveness. Therapy, at its best, offers the corrective experience of being known and accepted — not in spite of all the difficult, complicated, painful parts of a person, but alongside them. Every time a person risks bringing their shame into the room, and finds themselves met with genuine warmth and equanimity, a small but significant piece of that old story is rewritten.

Upcoming Workshop with Lisa Etherson

Want to find out more? The BTP Workshop on shame: *Shame: Working Effectively with Shame in Therapy*, will take place on Friday 17th April, 10am-4pm, with catch-up recording available if you can’t make it on the day.

Our trainer Lisa Etherson is a psychosexual psychotherapist and author who has spent many years researching Shame and developing the Shame Containment Theory (SCT). In this training she will help us understand and work with shame from an attachment perspective.

Further Reading

Brown, B. (2010). The Gifts of Imperfection. Hazelden Publishing

Nathanson, D. L. (1992). Shame and Pride: Affect, Sex, and the Birth of the Self. Norton

Lee, R. G., & Wheeler, G. (Eds.) (2003). The Voice of Shame: Silence and Connection in Psychotherapy. GestaltPress

If you’re interested in this topic you may like these articles too:

Shame and Connection in the Therapeutic Relationship

A Compassion Focused Therapy Approach to Shame

The Burden of Heritage & role of Sublimation

Join our Therapy Community on Facebook

Brighton Therapy Partnership has a private Facebook Group for therapists which might be of interest to you if you are on social media? We currently have over 2,3k members. You will need to answer all 3 Joining Questions and agree to the Group Rules to join the Group!

Click Here to Join *The Therapy Partnership* Facebook Group – Be Part of the Therapy Community!

* There are affiliate links in this post, if you buy a book using one of these affiliate links we will get a very small fee. It all helps! Thank you!