Taking the Sting Out of Shame

By Tim Clark

It’s one of those chaotic days in between lockdowns, filled with clients trying to squeeze in a massage before the inevitable next lockdown is announced.

I’ve started to notice a pattern.

“You’ll have to excuse the COVID kilos,” says one client.

Another one says, “I’ve been trying to get back to the gym but I’m useless. I just can’t find the motivation.”

And another: “I haven’t been taking many breaks from the desk, so I’ve turned into a hunchback.”

It seems that, for many, lockdowns are a case of more AND less.

MORE: weight, booze, sugar, stress and time at work than usual.

LESS: exercise, nutrition, relaxation and genuine self-care than usual.

Of course, I can relate. I’ve picked up some less-than-helpful habits during lockdown. (My baking game has improved exponentially, but those cakes don’t eat themselves.)

I can hear the guilt in some clients’ words – a little voice in the background saying, “I’ve been naughty. I’ve been lazy. I’ve given in to temptation and I’m going to need to put things right.”

But beneath other words lies something darker and more burdensome. It’s a voice that says, “I’m bad. I’m broken.”

Not just, “I’ve done the wrong thing,” but, “I am the wrong thing.”

That voice is shame.

Guilt and shame are closely related but they have some important differences.

Guilt brings with it some kind of opportunity to make amends. There’s something that can be done to make things at least a bit more right.

To make shame right, though, it feels like we would need to become a different person, or at least have a significant overhaul of our essence.

For most of us who are shame-prone, the odds of that dramatic change occurring seem pretty slim, so we adapt to accommodate the shame. We find ways to make it make sense in our lives. We actively look for confirmation of our shameful selves. Every minor criticism, blemish and perceived inadequacy serves to reinforce over and over that we are not good enough and help to solidify our shame until it feels like an integral part of who we are.

We also look for ways to mask our shame. We surrender our authenticity. We perform. We people-please. We overcompensate. We seek total control, or sometimes total escape. Anything to avoid letting other people see our shamed parts. 

It’s hard to mask some things when we’re on a massage table, our skin exposed, our bodies offered up for interpretation. It’s hard to hide our weight, our muscle tone or our pain.  

It’s no wonder people often arrive at a massage treatment with a pre-emptive apology.

“You’ll have to excuse the COVID-kilos” and “I’ve turned into a hunchback” are exactly this: apologies.

They might signal guilt or shame or both. They rest on the belief that I have sinned and maybe that I am irredeemable.

They are also a warning. They might be the client’s way of pre-empting the therapist’s disgust: You’re not going to like what you see.

Or of pre-empting the therapist’s criticism: I know you’re going to tell me off so I’m going to get in first.

Or even: Please don’t tell me off. I couldn’t take it.

They are the client’s way of letting in as much guilt or shame as feels manageable. Any more and it might destroy them.

So, what are we as massage therapists to do when our clients say these things?

Let’s take my first client’s comment – “You’ll have to excuse the COVID-kilos” – as an example. It seems likely that many of us will hear clients say this kind of thing coming out of lockdown, and it’s worth being ready for it.

Check In With Ourselves

Our first step is to be self-aware. Hopefully, we have some sense of our automatic thoughts, which could be anything from, I would never have noticed to Yes, you’ve really stacked it on.

If we notice something like that latter reaction, it’s going to be really important to acknowledge that there’s something in us that attaches guilt or shame to weight gain. We might have experienced body shame ourselves. It might be worth doing some focused reflection on it now, either alone or with a trusted other, so that you know what is your stuff and what is your client’s stuff when the issue comes up.

Professional Development Reflection Suggestion: Reflect on your attitudes to any of these issues: weight gain, inactivity, self-care. What shaped these attitudes? Where did you learn to see things that way? Tune in to your own inner critic. Whose voice do you hear when you have self-critical thoughts? Is it your own or is it someone from your past?

Ignore?

Of course, we have the option to ignore the comment altogether. Depending on our training, it might feel out of our scope of practice. Or maybe it feels like it’s too soon in the relationship and we’d rather wait until some more trust has built up.

But we also need to be aware that our silence might be taken as agreement.

Shame feeds on silence. It loves being left in the dark where no one can expose it. Shame-prone people will have no trouble interpreting your silence as confirmation that the shame should be left where it is.

It is an ethical dilemma for us. There may be no ‘perfect’ response.

But as with any ethical dilemma, it’s helpful to explore our options.

Empathise?

There are numerous ways we could be empathic in responding to this comment.

“As long as you excuse mine,” (or similar) is a possibility. It shows your client that you don’t consider them any more wicked or shameful that you consider yourself. The catch is: maybe you consider yourself quite shameful. In which case, the shame is shared but remains fundamentally the same.

Or how about: “Well, now that lockdown is over, hopefully we can get back to our healthier ways.”

It keeps the focus on health and manages to empathise (note: ‘we’ and ‘our’). It shows the client that they’re not alone in their struggles and may plant a seed for action.

But it also contains a barely perceptible slap on the wrist. Underneath is an assumption that we’ve strayed from the path and maybe deserve to be punished for it. It might even come across that ‘going back to healthier ways’ is the punishment.

Do we want the client to see healthy, nurturing behaviours as a punishment, or somehow less desirable than unhealthy ones? What if there’s another lockdown and they go back to the same habits? Or if they just can’t break their lockdown habits when it ends? What then?

Clearly, empathy can be helpful but it has its limitations.

Practical?

Maybe we shift the focus to practical steps to get the client back to where they want to be.

We could give advice or education on weight loss, but again we face scope-of-practice issues and the harsh reality that it might have little-to-no effect.

We could try some motivational interviewing like, “What do you think your diet/exercise regimen will look like now that lockdown is over?” which hands responsibility and autonomy back to the client.

In doing so, we’ve leap-frogged over the shame and put the focus firmly on the future.

Wherein lies more dilemmas: would it be more important for us to help the client lose the weight or lose the shame? Which one is the more significant health risk? And which one are we better positioned to treat?

These are particularly curly questions, and we can only really answer them for ourselves. But I will offer one final option and leave you to reach your own conclusion.

Professional Development Reflection Suggestion: What’s your take on these difficult questions? What are the arguments for and against your position? What evidence would you use to back up your position? 

Validate and Reframe

In certain circumstances, it might be possible to acknowledge what the client has said and suggest a new way of looking at things.

It’s not going to solve the client’s shame problem, nor is it our job to do so. But in just one sentence it might suggest a new way of relating to the shame.

It could sound something like: “I can see you don’t feel good about putting on the weight, but whatever you did during lockdown has gotten you here.”

This acknowledges the guilt or shame without shying away from it. It brings the guilt or shame into the light where it can at least be considered and maybe challenged. The client may not have even been aware it was there.

Also, it acknowledges the remarkable wisdom of the human organism to adapt in adversity. The adjustments of ‘more or less’ we’ve made during lockdown have felt necessary to manage the threats of a dangerous viral infection, emotional overwhelm, financial distress, isolation and social division.

Comfort eating and/or drinking, ‘slacking off’ and overworking were the body’s way of sustaining us while we were staying home, away from the virus, staying physiologically safe and keeping others safe. They were the body’s way of maintaining a degree of pleasure, connection, normality or purpose in a necessarily restrictive situation. How very clever.

When lockdown ends and the existential threat of the virus reduces, guilt and shame may kick in adaptively. The mind and body recognise that good health and physiological safety can now be best maintained not by hiding away but by good nutrition, exercise and work-life balance.

Any shame feelings that endure beyond that adaptive purpose are likely ingrained (or, as shame guru John Bradshaw would say, toxic) and may indicate referral for counselling or psychology.

Professional Development Reflection Suggestion: Which of these ways of responding suits you best? How might you adapt Tim’s suggestions to suit you and your way of communicating? 

In Conclusion

Helping people with their shame is difficult for even seasoned mental health professionals. In most cases, it’s the rusted-on build-up of a lifetime of beliefs that have been confirmed over and over again.

We should expect then that it might take a whole lot of corrective experiences to scrub away the shame and reveal self-acceptance. With every massage, every word of validation and every thoughtful reframing of their experience of shame, we have an opportunity to offer our clients one of those experiences.

About the Author

Tim Clark is a massage therapist and psychotherapist in private practice in Melbourne. His lockdown achievements include two enormous chocolate fudge cakes, a flourless citrus cake, a lemon yoghurt cake, two pear tea cakes, two passionfruit bundt cakes, three Dutch apple breads, one passionfruit coconut crepe cake and two apple cider doughnut cakes. “That probably sounds like I’m exaggerating but I’m not. I really have achieved that much.”

Ed: And it looks like we may have figured out how to cater for the next in-person AMT Conference.