Shame in the Therapy Room
- Aug 17
- 8 min read
Updated: 21 hours ago
Ryan Campinho Valadas is a specialist psychotherapist, educator, and public speaker working in the areas of relational health, sexuality, identity, and organisational culture. He is based in the UK and works with a diverse range of individuals, community groups, and organisations.
It is common to write this kind of article with current or potential clients in mind, but since I started teaching trainee therapists, I’ve become increasingly interested in what goes on in the therapist’s world. So, to start us off, I wanted to share something personal and then expand on it with theory and professional reflections: there is a type of intense, overwhelming, seemingly automatic response I have to certain life situations that surprises me to this day.
It has never occurred in an actual therapy session with a client, but it has in other professional contexts. This has led me to interrogate more deeply what could be going on for me, even after all the personal therapy I’ve undertaken.
I experience it as an absolute, pervasive, and enveloping sensation which takes control of body sensations, behaviours, and completely shuts down my rational mind. It is also a strange out-of-body and dissociative experience where I can see what’s happening, but I’m not able to stop it. It completely cuts me off from any relational tool, capacity, or dynamic, and I have had many conversations over the years about the impact it has on others. I understand it intimately as a survival response from my adolescence, but I’m still caught by surprise when it happens in my adult life, mainly because it's so infrequent now.
For many years, I framed and named this as a trauma response because it illustrates and mirrors the very real and automatic nature of a fight/flight/freeze/fawn activation. I have explored it further through the lens of anxiety, depression, anger, rage, and fear. I don’t think that’s wrong or misguided, but I was curious about what else could be present.
In a client, for instance, I may notice an unusual response which impacts their perception of safety in the room, their body language, their capacity to verbalise what’s going on, and their relationship to me. There is a heightened sense of heaviness in the transference and a shift in energy in the room. I tend to experience this as something unclear and unknown in the moment, but something that I can definitely feel physically and emotionally.
One of the main themes running through most modules of the specialist postgraduate diploma that I teach in Psychosexual and Relationship Therapy is shame. At the Contemporary Institute of Clinical Sexology, the curriculum includes a modern theory of shame developed by Lisa Etherson called Shame Containment Theory (2023). It has been through the learning and teaching of this specific theory and framework, which wasn’t part of my own training, that I have found an additional lens through which I could explore and understand my personal response further, as well as understand my own clients better.
This is also why I love teaching–it is a humbling and constant reminder that I don’t know everything, and never will. There is always room for more learning.
Exploring different facets of shame
In what I consider a very insightful analysis of shame, Etherson qualifies it as “a complex emotion that is often hidden” (2023). There is no universal definition of shame, and I think the following perspectives offered by additional and different theorists illustrate this well, a reaction to the danger of rejection, failure, exposure or abandonment (de Thierry 2018), a self judgement resulting in worthlessness and a desperation for perfectionism (Cozolino 2016), being seen in a diminished sense (Kaufman 1980), not feeling worthy of love and belonging (Brown 2012), an emotion that is experienced by shock and pain where words and thoughts become repressed (Herman 2012), its origins are relational and it needs relational attention, even though it feels out of reach of relational closeness (De Young 2015).
Taking all of these into consideration, it is easy to see not only how complex it is, but also how easily it can be perceived and identified as a range of other lived experiences that we are more familiar with, such as fear of failure and rejection, abandonment challenges, self judgement, imposter syndrome, anxiety, professional presenteeism, feeling unworthy, shyness, dissociation, anger, trauma, and a range of relational difficulties. If you could pause here for a moment and consider this, in the more intense and overwhelming emotional and relational experiences that you have in your life, are you able to identify shame within them? How does that change the perception you have of those experiences?
How might shame be hiding in your life and in your clients' lives? Behind what? For what reasons? If I experience something through an anxiety response, then it’s quite common to just assume that I’m feeling anxious about something and employ therapeutic interventions which directly address that. But if shame is also part of that response and continues to go unchecked, then something has been missed in my personal reflection and relational interaction, including in a therapeutic relationship. This is why I have been particularly curious about this dynamic. What have I been leaving unchecked, and to what extent?
Embedded in the tradition of attachment theory, shame is considered by Etherson as something deeply important to self-protection and relational dynamics. It considers early life experiences and how they influence the development of the self, particularly how someone might cope with instances of rupture and repair in adulthood. One of the concepts I found particularly helpful in understanding my own life and the patterns of behaviour in my clients was the idea of strategies to contain the experience of shame, which we start developing as infants and progressively turn into ever more sophisticated patterns of response within ourselves, towards others, and in relation to the world around us. Contained shame is the lingering feeling we are left with after suffering attachment injuries in childhood, whilst uncontained shame is the experience of reconnecting to these feelings and ruptures in adulthood. Thus, the defences we create on the cognitive, emotional, and behavioural levels between childhood and adulthood are represented by the ways we carry ourselves in our day-to-day, as well as the more extreme responses we have to overwhelming challenges we encounter during moments of upheaval and crisis. It is across these complex levels of patterns that shame can be so well hidden, and even forgotten about.
Witnessing without flinching: Being held and accepted
Specialising in psychosexual therapy opened my life up to many things, and one of them was the shaming that many counsellors and psychotherapists impart on their clients in more generalised therapy. I remember the first time a client told me that they had sought me out specifically because they had been shamed by their therapist of many years when they brought up the topic of gay sex in their therapy sessions. I remember feeling sad and thinking how unfortunate this experience was for them, and how rupturing it must feel to anyone in that situation. I worked with that client for many years after that, but I kept meeting new clients in similar situations, and this pointed to a problem that was perhaps more common than I had ever thought possible.
I consider sex and psychosexual challenges to be a particularly sensitive topic and can see how it would evoke an array of feelings and reactions based on someone’s upbringing, set of beliefs and values, lived experience, cultural and religious background, and even clinical training. It is one of the “big three topics”, as I lovingly call them, that people tend to avoid: sex, death, and money. This makes it easier to illustrate in terms of considering shame in the therapy room, not just the client’s, but also the therapist’s.
What has gone unchecked in the therapist’s own process of self-examination, reflection, and reflexivity about sex that could be simmering in the background and be suddenly released and felt with such impact that a client would feel rejected, shamed, judged, and hurt? When I first heard the experience that my client had had with their previous therapist, I also remember putting it down to the therapist’s judgemental views and biases on sex, potentially informed by specific beliefs, values, and life experiences. But a few years later, I can hold more curiosity towards that kind of situation and wonder what else was present in that moment and what the external presentation of judgement was protecting and hiding in that person’s life.
This is why I feel really passionate about inviting therapists, and anyone actually, to take some time to consider shame in their lives. Where does it start and with whom? How does it manifest externally and internally? What strategies have you developed over time to keep it contained, in both helpful and maladaptive ways? What areas of life and topics are more sensitive and prone to it?
A shame response is informed by a person’s lived experience. Andy Jackson’s poem ‘The change room’ (2021) captures a beautiful and intensely human moment in a public swimming pool. In the interaction, Jackson is confronted by a child’s inquisitive and persistent look at his severe spinal curvature connected to Marfan Syndrome, and feels the weight that this evokes:
“As my bones crouch into an old shame I thought I’d left behind.”
That line includes much of what I’ve been discussing here: the physical, emotional, behavioural, and metaphorical crouching of our sense of self, the surprise at feeling something that we know is old and had perhaps considered “fixed” or “sorted out”, or in therapy language, “fully processed”. But is there such a thing as fully processed? The more the years progress, the more I realise and suspect that there are certain things that will always be present within us and sensitive to life’s unexpected and diverse triggers. We may experience them less often, or with less intensity, or recover more quickly from the overwhelm, but they linger, perhaps as an essential part of our sense of self which we refuse to see as such.
By remaining open to this kind of work, we can guarantee more honest, grounded, kind, curious, and tender relationships with our loved ones, as well as with the people we support in a professional capacity. By remaining unflinchingly open and familiar to our own shame, we become more equipped to help others remove the heavy power that shame may hold over them. The great gift that the therapeutic relationship can offer here is in making space for the experience of being known in a place of deepest unacceptability, without being judged or abandoned, but witnessed, accepted, and cared for.
Read more from Ryan Campinho Valadas
Ryan Campinho Valadas, Therapist, Educator & Trainer
Ryan Campinho Valadas is a specialist psychotherapist, educator, and organisational trainer based in the UK. With 10 years of experience in psychotherapy and almost 20 years in public speaking, community organizing, and advocacy, he is interested in how social, cultural, and global dynamics influence our daily lives. Ryan specialises in psychosexual and relationship therapy, LGBTQ+ wellbeing, male mental health, and relational health in organisations. The main intention is to help people build stronger connections to their identities, desires, relationships, and life journeys.
References:
Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. Gotham Books.
Cozolino, L. (2016). Why therapy works: Using our minds to change our brains. W. W. Norton & Company.
de Thierry, B. (2018). The simple guide to understanding shame in children: What it is, what helps and how to prevent further stress or trauma. Jessica Kingsley Publishers.
DeYoung, P. A. (2015). Understanding and treating chronic shame: A relational/neurobiological approach. Routledge.
Etherson, L. (2023). Shame containment theory—a new approach to shame. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 17(2), 141–154. https://doi.org/10.33212/att.v17n2.2023.141
Herman, J. L. (2012). Shattered shame states and their repair. In J. Yellin & K. White (Eds.), Shattered states: Disorganised attachment and its repair (pp. 157–170). Karnac Books.
Jackson, A. (2021). Human looking. Giramondo Publishing.
Kaufman, G. (1980). Shame: The power of caring. Schenkman Publishing Co.
