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Title: Understanding and Treating Chronic Shame: A Relational/Neurobiological Approach

Author: Patricia A. DeYoung

ISBN: 978-1-138-83120-9


Understanding and Treating Chronic Shame is a manual for therapists on a variety of methods and theories for connecting with clients suffering from chronic shame. It focuses on interpersonal approaches (relationship between therapist and client mostly) and shame as an relational experience. The book covers understanding shame (“what is”, theories, relational and biological components, regulation/dysregulation, narratives, assessment) and treating shame (prerequisites, right-brain connection and integration, dissociation, transference/countertransference, relationship between client and therapist, long term care/maintenance).

Writing Style:

This book is intended for use by therapists working with chronic shame in their clients. It is not aimed at the general public. That said, the writing is very accessible, even if the content punches you in the face multiple times. This technically isn’t a self-help book. It is more of a help-others book or a I-wish-others-would-do-this-for-me book. It teaches jargon, technique, and theory. It is surprisingly thin, but it is dense with information. No matter who reads it, it is likely to be a slow and hard read. It assumes a background of training in psychotherapy.

The author, Patricia DeYoung, is a practicing relational psychotherapist and teacher/professor of Relational Psychotherapy in Toronto. She has a second book on relational psychotherapy (Relational Psychotherapy: A Primer, 2nd ed.) that I haven’t read yet.

My Opinion:

The opening paragraph of the Introduction sums up the book nicely:

“Shame hurts. If our shame is exposed, the pain can be unbearable. To save ourselves, we push shame away as fast as we can, covering for it with more tolerable states of being. These states of being are what we come to know of shame, both in ourselves and others. But they are compensations and collapse, masks and sleights of mind; they are not shame itself. What is shame itself? This book proposes that, despite its many disguises, shame can be understood as a unique, specific kind of interpersonal experience. This understanding of shame helps us see what’s behind the camouflage. It also helps us as therapists, making interpersonal contact with our chronically shamed clients in a way that can ease their suffering.” (-Page xii)

WARNING: The contents of this book, if they apply to you, are something that would be best faced with the help of a competent and trusted mental health professional. [1]

Just because a book is in the psychology/self-help section of a book store doesn’t mean that it is a SELF-help book. A premise of self-help marketing is that YOU CAN FIX YOURSELF (which also assumes that you are broken). If the reader can’t do that, then they may be left feeling like they failed or that there is something wrong with them. Thing is, we CAN’T always just “fix ourselves” and there are lots of legitimate reasons why that may be so. These can range from “we aren’t broken” to “the problem isn’t us” to “we don’t have the expertise” to “this triggers our issues”, and so on. This book is very clear that it is presenting a therapy that is performed as part of a relationship between a person experiencing shame and a regulating other[2].

What this book can offer the self-help reader is: a clearly written description of the experience of shame and disintegration of self; some understanding of why it is so hard to talk about shame; some exposure to the language and treatments used in therapy; and some idea of what to look for and avoid in therapy. It may also give a sense of recognition (and the emotions that go with that) of what one is going through and what the regulating/dysregulating others in their life are doing that helps or harms. [1, 2]

Which brings me to the other pervasive premise in self-help marketing: the idea that the reader should be able to fix others and make everything okay for them. If the reader can’t, then SOMEBODY IS TO BLAME (preferably not the reader). This idea can be dangerous. This book has some excellent information on being an effective regulating other. It also points out that there are prerequisite skills (chapter 6) that are necessary if a therapist is to work with shame without causing further damage (to the client or the therapist). This is heavy shit. While being a regulating other (and avoiding being a dysregulating one) is a normal part of human relationships (ex: Parent-child, partners, friends, etc [2]) and this book does have advice for that… it won’t change the reader from a clueless newb into a competent therapist. It isn’t meant to.

That said, Understanding and Treating Chronic Shame is amazing at explaining what chronic shame is and treatments for it, and it has an accessible writing style that I rarely see in textbooks/teaching books (especially when the topic is this difficult). Reading it may hurt.

Evil Overlord Assessment:

Keeping your victims off balance is one of the essential elements of Keeping Someone With You Forever and it can be a fine line to manage successfully. Finding the right target makes the whole thing simpler. For a target with chronic shame, dysregulation is like a BIG RED BUTTON of DOOM. Convince them that you are someone they want to trust or need to trust, then HIT THAT BUTTON any time you want them to fall apart. They won’t be of any use to you while they are in pieces, but they also won’t be of any use to themselves either.


[1] Here are two (American) blog posts on finding a therapist that may be useful in your search (YMMV): How to Shop for a Therapist and How to Get the Most Out of Therapy. There are more posts and articles on this topic out there. It is worth thinking about what makes a therapist a good fit for you and your needs. Not every therapist is a good fit or even competent. Firing one, or deciding to use someone else (for any reason), is something that happens.

[2] “Regulating other” and “dysregulating other” are terms related to attachment theory. As used in this book, they mean “a person on whom I rely to resound to my emotions in ways that help me not to be overwhelmed by them, but rather to contain, accept, and integrate them into an emotional “me” I can feel comfortable being” [definition of “regulating other” from page 21] and “a person I want to trust — and should be able to trust — to help me manage my affect or emotion. But this person’s response to me, or lack of response to me, does exactly the opposite: it does not help me contain, accept, or integrate” [definition of “dysregulating other” from page 21] respectively.


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