Academic journal article Journal of Mental Health Counseling

The Toxicity of Shame Applications for Acceptance and Commitment Therapy

Academic journal article Journal of Mental Health Counseling

The Toxicity of Shame Applications for Acceptance and Commitment Therapy

Article excerpt

Although shame is a detrimental emotional state often found in a variety of mental health concerns, treatment approaches for addressing it are scarce. Acceptance and Commitment Therapy (ACT) is an evidence-based treatment practice that has been effective in several applications, including the treatment of shame (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Luoma, Kohlenberg, Hayes, & Fletcher, 2011). ACT focuses on the development of six core skills for increasing client psychological flexibility. The article presents primary ACT techniques, case studies, and considerations for counselors.

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Mental health counselors today are challenged to work with a variety of client concerns, such as self-harm, depression, anxiety, eating disorders, interpersonal conflicts, self-criticism, feelings of inferiority, and personality disorders. Whereas each area presents some level of difficulty, certain clinical concerns present significant clinical challenges. For instance, when working with survivors of abuse, solders returning from combat, or clients struggling with addiction, counselors may feel inadequate, refer to a specialist, or need additional training (Demers, 2011; Ford & Smith, 2008; Janikowski & GloverGraf, 2003; McBride & Markos, 1994; Salyers, Ritchie, & Luellen, 2005). This is evidenced by the development of specific certifications, such as the Master Addictions Counselor certificate (MAC) provided by the National Board of Certified Counselors (NBCC) or the posttraumatic stress disorder training services of the Veterans Administration.

To further complicate matters, clinical concerns are often interrelated. For example, those struggling with abuse and combat-related stress often seek relief in addictive disorders (Ford & Smith, 2008). Since co-occurring disorders can make diagnosis and treatment complex, it may be useful for helping professionals to examine factors they may have in common. One is often the presence of shame (Cheung, Gilbert, & Irons, 2004; Gilbert et al., 2010; Gilbert & Miles, 2000; Kim, Thibodeau, & Jorgensen, 2011).

Much has been written about the impacts of shame (e.g., Lewis, 1971; Martens, 2005; Parker & Thomas, 2009; Tangney, 1996). Wiechelt (2007) defined it as a painful emotional state based on a self-perception of being vulnerable or flawed. When this painful state presents itself in mental health concerns, it may exacerbate symptoms or complicate treatment. For example, in victims of abuse, shame can present as an attack of the self, a desire to hide or die, or self-loathing (Feiring, Taska, & Lewis, 1996; Kim, Talbot, & Gicchetti, 2009; Lewis, 1971). As victims of abuse try to insulate themselves from the pain of shame, they may exhibit increased aggression, self-harm, verbal self-denigration, or severe depression (Cheung, Gilbert, & Irons, 2004; Gilbert et al., 2010; Gold, Sullivan, & Lewis, 2011). They often regard themselves as bad, at fault, or blameworthy (Feiring et al., 1996). Similarly, for soldiers returning from combat, shame may manifest itself as thoughts of being weak and at fault, which impedes them from seeking assistance (Brunet & Woll, 2011; Harman & Lee, 2010; Hoge et al., 2004; Kim et al., 2011). Finally, in the treatment of addiction, which reportedly carries more shame than other mental health concerns, shame perpetuates a cycle that actually works to maintain addictive symptoms (Wiechelt, 2007): To numb shameful feelings, individuals abuse substances, which then provoke more feelings of shame and humiliation.

Given its impact on mental health concerns, it has been suggested that treatment target shame directly (Parker & Thomas, 2009; Wiechelt, 2007). However, as noted by Luoma, Kohlenberg, Hayes, Bunting, and Rye (2008), the literature has little to say about the specific treatment of shame. This article reviews the complexity of shame and presents a rationale for using Acceptance and Commitment Therapy (ACT) to treat it. …

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