Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma

by Patricia A. DeYoung

A masterful synthesis of relational and attachment theory, neurobiology, and contemporary psychoanalysis, Understanding and Treating Chronic Shame has been internationally recognized as an essential text on shame. Integrating new theory about trauma, shame resilience, and self-compassion, this second edition further clarifies the relational, right-brain essence of being in and with the suffering of shame. New chapters carry theory further into praxis. In the time of a national Truth and Reconciliation Commission and a global Black Lives Matter movement, "Societies of Chronic Shame" invites therapists to deepen their awareness of collective societal trauma and of their own place within dissociated societal shame. "Three Faces of Shame" organizes the clinical wisdom of the book into clear guidelines for differential diagnosis and treatment. Lucid and compassionate, this book engages with the most profound challenges of clinical practice and touches into the depths of being human.

Genres: Psychology, Nonfiction, Self Help, Mental Health, Counselling, Audiobook, Personal Growth

310 pages, Kindle Edition

First published February 9, 2015

Reviews

[Morgan Blackledge · Rating 5 out of 5]

Let’s talk about shame.

SHAME!

Shame is a very social (relational) emotion.

People develop healthy (appropriate) shame in early childhood (beginning around age 2) as we become aware of our parents, and later peers expectations regarding our behavior.

Socialized (as it were).

Louis Cozolino writes: “appropriate shame and guilt supports the development of the social conscience, deepens our empathetic abilities, and enhances our self-esteem as a caring person. In contrast, core shame develops as a function of overwhelmingly negative attachment experiences. The emotions of core shame are distinguishable from healthy shame in that they are not related to behavior but to the experience of the self. Children and adults with core shame come to experience themselves as fundamentally defective, worthless, and unlovable. Core shame is the polar opposite of self-esteem.”

Oh man.

What he said ☝️

I’m feeling it.

In other words.

If you grow up in a neglecting, or unpredictable, or abusive emotional environment. And you are held in that state of yuck for too long. You emerge into childhood, adolescence and later adulthood feeling broken, or empty, or unworthy of love, and maybe like an imposter, or that you have to be extra, or perfect just to get your basic needs met.

You don’t so much think all that as FEEL it.

You SENSE it at the CORE of your being.

It’s a VISCERAL type of knowing that we rarely come to explicitly understand. But that DOMINATES our lives, at work, school and especially….

In relationship 🫥

Core shame is the hallmark of developmental trauma.

And the thing behind the thing with most:
- addiction
- anxiety
- depression

I could go on.

This book is about a very similar (almost identical) construct.

Chronic shame.

Patricia DeYoung defines chronic shame as “an experience of one's felt sense of self disintegrating in relation to a dysregulating other.”

Have you ever been put on the spot, or felt judged or rejected, and part of you just freezes?

Goes off line?

Goes blank?

Can’t talk?

Can’t think?

You become disoriented.

Dissociated.

You wish you could disappear.

Your sense of self disappears.

If the answer is yes, I imagine your next question might be:

So what can one do about this?

That’s what this book is all about.

Understanding (and importantly) treating (if you’re a therapist) or recovering from (particularly if you’re a therapist) chronic shame.

I could write a book about this book.

But it would be better if you just read the book.

5/5 stars ⭐️

[Antigone · Rating 4 out of 5]

In her first book, Relational Psychotherapy, esteemed Toronto analyst Patricia A. DeYoung introduced this branch of treatment to those new to its techniques. Here she takes on chronic shame from that same relational perspective.

Shame receives very little attention from reputable therapists, largely because it is difficult to address and frequently unresolvable. Introduced through parenting at an early age, a healthy application of shame strengthens boundaries that lead to ethical behavior and desirable social outcome. There are, however, caretakers who employ shaming to gain and maintain personal advantage over their charges. In so doing, they damage areas of critical importance to a developing identity - among them confidence, assertiveness, self-respect and self-worth. This damage is viewed by professionals as essentially irreparable because the voice of that destructive individual becomes hardwired into the function of a child's critical thinking. Most analysts, upon encountering a client's shame, will do their best to construct a work-around. DeYoung takes a more confrontational stance, suggesting that shame (when and if a patient is willing to allow it to appear) be given "light and air;" that bringing it out of silence and into the view of a compassionate other will, in many instances, help with its management.

DeYoung's work is highly-detailed and filled with case examples. Its relational approach, while certain to be dynamic for practitioners, may prove painful for those struggling with the conflict - possibly to the point of provoking anxiety. Take care with this one. The material can get a little intense.

[Barb · Rating 5 out of 5]

This book helped me complete my long-term therapy for attachment issues.

Processing anxiety and anger from child abuse and neglect in an excellent long-term therapy, my therapist and I found ourselves stuck at a deep point after years of productive work, unable to understand some of my recurring anger at her. A Psychology Today article alerted me that my anger might come from shame. I looked shame up on my Kindle and chose this book, which led my therapist and I through processing my shame. Once my shame was processed, the anxiety and anger evaporated. I am grateful to live in a time when we can easily access the work of deep thinkers on very specific subjects via a simple five-minute Internet search. Thank you, Dr. DeYoung.

[Tess Klaver · Rating 5 out of 5]

This book is, hands-down, one of the best therapy books I’ve ever read. DeYoung posits a cohesive, understandable and neurobiologically informed theory of shame and its treatment.

This book was beautifully written, provided insights that were relevant for myself and potential clients, and adds a much needed and significant layer to the current literature available regarding shame within therapy.

I will be reading this more than once, and would highly recommend it to anyone in the field.

[Nina (ninjasbooks) · Rating 5 out of 5]

I learnt so much from this book and can’t recommend it enough. It reminds me to make every session with my clients a nonjudgmental empathic hour, not hurrying too much. The beautify of being just being there, slowly discovering how the past affect the now, was clear. Interesting case stories made the theory even more interesting.

[Pyroclastic Ash · Rating 5 out of 5]

Thorough review of shame, its presentation in treatment, and how clinicians can provide compassion and support to clients.

[Kate Ahl · Rating 5 out of 5]

This is an accessibly and engagingly written, comprehensive overview of the phenomenon of shame as understood in a variety of psychotherapeutic and neuroscientific traditions. Exploring the relational roots of chronic shame, the author provides vivid case studies to illustrate the ways shame is often the cornerstone of other behaviours (such as addiction), 'conditions' (depression, anxiety, personality disorder, dissociation, etc), and difficulties in relating that might be a client's ostensible presenting problem. Proposing a relational approach to working with shame in ways that allow it to be spoken about openly, and to give a reparative experience of relationship that encourages a visceral, 'right-brain' experience of being accepted with all their human fallibilities, the author resists the temptation to offer a cure, but suggests ways of 'managing' chronic shame, through knowing how to identify it and understanding how it operates in ourselves and our clients.

[Alan Bowman · Rating 4 out of 5]

This book does a good job of integrating a lot of heavy and complex theoretical material into something coherent and helpful. In my view it is not a beginners text and you will get the most from it if you are already comfortable with some principles from interpersonal neurobiology, object relations theory, and self-psychology. This text is certainly a springboard for further thinking and reading, emphasis on the further reading. It will be worth a read if you are a therapist working with complex trauma, relational difficulties, or with people who have had adverse life experiences in their developmental history. I listened to the audiobook version and I was impressed by the narration. At times the book dives into some pretty complex (and verbose) stuff, but the narrator holds up pretty consistently across the book, which made taking it in much easier.

[Jack · Rating 5 out of 5]

Should be read by all therapists

I would recommend this book to all therapists and also clients as it explains exactly how to deal constructively with shame. Also how to deal with shame when it comes up in the therapeutic relationship. A very easy to understand honest book.

[Holly Greenidge · Rating 4 out of 5]

Mind-blowing, life-changing. I only give 5 stars if it was also enjoyable to read and/or it's one I'd keep going back to.

[Robert Jones · Rating 2 out of 5]

Really more for therapists than everyday readers. I put it down because there were so few practical applications for the average person. Even though it was interesting and made me think, it just motivated me to find another book geared towards the average person. In addition to the lack of practical insights, the language and terminology of the book was pretty far above my head too. And I read empirical self-help books regularly.

[Katharine · Rating 5 out of 5]

The best book I’ve ever read on shame. Loved it. She weaves in personal vignettes with theory.

[Mason Fraley · Rating 5 out of 5]

Very dense, will definitely be reading again at some point

[Achidimama · Rating 5 out of 5]

Insightful and helpful tools prov8ded in a clear and simple way.

[wisepeel]

"Shame, as specifically a right-brain experience, is a relatively pure form of shame affect that overwhelms and wipes out sense of self. So, essentially whenever you're shamed, you kind of disintegrate from the inside and lose who you are and it leaves you vulnerable to the person shaming you. The ability to bring yourself back to your sense of self is how you determine if it's chronic or acute. I've experienced religious shame. There's so many rules when it comes to religion and so much hypocrisy and it's kind of just embedded within society. I know we separate church and state, but everyone knows the concept of "One nation under God", and how you follow certain rules, and if you don't follow these rules, you're shamed and you're outcast. I went to church every Sunday. It can go on for like 10 hours. It's like, well, if we haven't caught the holy ghost yet, he's not coming."

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[Gazanfer · Rating 3 out of 5]

a bit redundant on the right vs left brain integration. but insightful and clear about affect theory. im not giving 5 stars because there are better books addressing chronic shame imo. like the haunted self or janina fisher's healing the fragmented selves of trauma survivors

[Tara · Rating 5 out of 5]

Fantastic.

[Stephen Grant · Rating 5 out of 5]

One of the best books in my counseling library.

[Britt Caron · Rating 5 out of 5]

By far, the most helpful book, practically and theoretically, that I have read in my training as a therapist. A must-read!

[Bobic Boban · Rating 5 out of 5]

Dozvolite sebi da upoznate stid. Pomozite sebi i ljudima oko vas.
Izvanredna knjiga Patricie DeYoung, Hronični stid, vodi nas od tihog, svakodnevnog osećaja “da nešto nije u redu sa mnom” do dubljeg razumevanja kako stid nastaje, kako se maskira — i kako može da se zaleči.

DeYoung ne piše sa distance, već sa saosećanjem. Kroz psihološke uvide i stvarne primere pokazuje kako stid postaje temelj ličnog identiteta, kako utiče na odnose, samopouzdanje, čak i na telo. Naučićete da prepoznate mehanizme bega od stida: perfekcionizam, povlačenje, zavisnosti, emocionalnu disocijaciju — ali i da ih nežno prepoznate kao pokušaje samoodbrane.

Ova knjiga ne nudi gotova rešenja, već prostor za razumevanje i integraciju — kroz povezanost, empatiju i kontakt sa sobom. Pisana je stručno, ali jasno i korisno svima koji žele da razumeju sebe dublje.

•Ne moramo da budemo savršeni da bismo zaslužili pripadanje — samo viđeni.

•Ne stidimo se zato što smo loši — već zato što smo naučili da nismo dovoljno dobri.

•Mnogi ljudi sa hroničnim stidom izgledaju sasvim ‘normalno’ — dok iznutra vode rat protiv sebe

•Stid nije samo osećaj. To je cela priča koju smo naučili o sebi.

[Kristina Skaisgirienė · Rating 5 out of 5]

Puiki knyga, kuomet kyla klausimų dirbant su gėdos jausmą išgyvenančiais klientais. Autorė pavyzdžiais, remdamasi įvairiais literatūros šaltiniais, supažindina su šiuo labai intensyviu jausmu: jo susiformavimo aplinkybėmis, žmogaus gebėjimu "būti" su gėda, kai kartais tas buvimas adaptyvus, kartais – ne, kaip psichoterapeutams "matyti" šiuos pacientus ir su jais komunikuoti. Praplečianti akiratį ir duodanti stimulą galvoti ir pergavoti, dar kartą paskatinanti, kad kartais svarbiau dirbti ne interpretacijomis, o santykiu.

"Chronic shame is first felt sense of nobody understands or cares about me, with the felt implication, so I'm not worth care and understanding. Ideas about being inadequate, wrong or flawed follow in order to make sense of the feeling."

[Elizabeth · Rating 5 out of 5]

So good. For all my therapist friends this is a must read. This book has really sharpened my knowledge on the subject of shame and gives practical useful information about treating shame. It also validates the things we already do to counter shame and gives a wonderful neurological description of why those things work. For my non therapist friends: This book is still useful in understanding this complex human emotion that is undoubtedly in you and those around you.

[Steve · Rating 5 out of 5]

4.5/5

An excellent book on the topic of shame for practicing therapists. I am not someone who normally highlights a book, but I had to pull it out for this one so I can come back to important parts. She weaves together clinical practice and neuroscience effectively throughout, making it both practical and yet drawing from a strong theoretical base. Probably a book I will go back and re-read, if nothing else what I underlined.

[Zion Lily · Rating 5 out of 5]

Patricia DeYoung is incredibly articulate and thorough in this book which carries deep and holy stories of shame from therapy rooms and personal life. Littered with psychological jargon and dense dense pages (as well as therapeutic approaches for confronting shame), this book is one to take slowly and in chunks— not to be listened to on audible, but read over and over again, underlined and wept into.

[Miguel · Rating 5 out of 5]

De Young knowledge of shame shines through wonderfully in this book. Overall quite a dense high level book but balanced well with anecdotes and information that is immediately relevant. Read it slowly and really absorb the book to get the most out of it.

Until proven otherwise after this book, I believe shame is an important part of therapy and all therapists should be shame-aware

[Kmc · Rating 5 out of 5]

This book has been really helpful in my clinical work as a psychotherapist! I love how Patricia brought in the neurobiological explanation with Schore's research, Gilbert's relational style in compassion focused therapy, and her provision of examples on how as a therapist, we can communicate in a right brain to right brain manner with our service users.


Highly recommended.

[M W · Rating 5 out of 5]

Should be required reading for all psychotherapists

This book should be required reading for all those looking to help others through all branches of the “talking therapies”. It brings together so many theories and shows how they link together and overlap in our understanding of this core condition of so many people in therapy

[Kalina Wojciechowicz · Rating 4 out of 5]

Autorka zauważa, że wstyd pojawia się w kontakcie z deregulującym innym i że jedynie prawopółkulowy kontakt z pacjentem może być skuteczny. Żadne racjonalne analizy, logiczne omówienia nie przyniosą skutkow, jakie da szczera, akceptująca, empatyczna relacja z terapeutą.

[orlando! · Rating 1 out of 5]

hokey

[Carol · Rating 5 out of 5]

Metabolizing shame is a skill we all deserve to have developed. This book is academic but the perspective and freedom if offers are worth it a thousand fold.