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"Big Boys Don't Cry" Diagnosis & Treatment of Male Shame and DepressionMale Depression continuing education psychologist CEUs

Section 4
Internalized Shame

CEU Question 4 | CE Test | Table of Contents | Depression
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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In the last few tracks, we discussed sources of male shame and ways to interrupt shame generated in the present.

Let's now look at some methods for reducing the maintained shame that men often carry with them. First, we'll look at "Redefining Relationships." Then, we'll discuss a "Reparenting Technique."

As you know, many men stay in relationships that sustain their shame: relationships that feed their depression. Even with therapy, it might be nearly impossible to truly overcome the shame and depression if their close relationships perpetuate hurtful and humiliating feelings.

My colleague, Ted, had a client who complained about his tense family relationships. The client, Jeff, was a 30-year-old salesperson whose father was constantly asking how much he paid for things. Jeff said that every time he told his father how much, the father would shame him in some way, either by saying he paid too much or too little for a certain thing. If you recall information from a previous track, Jeff's father was practicing "Intentional Shaming."

Redefining Relationships
Ted, the therapist, told Jeff that he had to decide how important his relationship with his father was to him. He had to either tell his father how he felt or allow himself to become even more alienated from him. Jeff said he did want to keep a good relationship with his father, but he didn't want to be shamed anymore. Ted then encouraged Jeff to refuse to answer his questions about prices, thus redefining the way they interacted. Think about your clients. Do you have any with whom a similar "change of response" technique might work?

After that session, Jeff bought a sofa and his father asked Jeff what he had paid for it. Jeff said, "I think we'd be better off if we didn't discuss how much I pay for things." Jeff said his dad was very surprised to hear his son defy him like that. But from then on, Jeff stated that his relationship with his father was much better and that he didn't feel shamed so much anymore.

Jeff had, in a way, redefined his relationship with his father. In the next session, Ted, the therapist, asked Jeff what he felt he owed his family. Jeff stated, "I know what I owe to my family is to go home if a family member were dying. Beyond that, I'm not sure." Ted then asked Jeff what he would freely give. Jeff anaswered, "I would give my father continued contact. By that I mean I would keep in touch with my father in some way."

Ted patterned his questions after Kaufman's ideas on releasing shame from everyday occurrences. As you know, it's important for men to determine what they are obligated to do and what they can avoid doing if it causes them shame. If Jeff's dad were to shame him again, Jeff could assert himself and do what he chose to do. In this way, Jeff had redefined his relationship. He had changed his behavior whenever his father shamed him.

Technique: Reparenting
Now that we've talked about "Redefining Relationships," let's move on to the more specific technique of "Reparenting." As you know, a large part of internalized shame has roots in early childhood scenes of shame. A depressed man can go back to the little boy inside and comfort him. Thus he becomes the good father to himself he probably never had.

I know you've heard about this technique before, but let's go over the details. Here is an example of what a therapist might tell his or her client as part of the reparenting process. As you listen, think of how you might put this in your own words and convey it most effectively to your client. Providing you are not driving your car, of course, as you listen to this CD, do this exercise as I describe it.

"Relax the muscles in your body... and make yourself comfortable in your chair. Now, breathe very slowly in and out. As you exhale, concentrate on draining the tension from your body. I'm going to share with you some images. If you think of an image that works better for you, go with it. Anything you experience will be helpful. Imagine you are descending a staircase. Really feel the sensation of walking, of putting your foot on each step. When you reach the bottom, you're in long a hallway. At the end of the hallway, there's a light. Walk toward the light. You'll see that it's coming from your room.

"Walk into the room and take it all in... It's your bedroom from when you were five or 10 years old. Choose whatever age comes to your mind first, whatever age is easiest for you to picture. Or, if you did not have a bedroom, the room you're seeing is a safe place you would go to be alone or feel safe. Walk around the room and touch everything you see. Notice how the furniture is placed, what color the walls are, whether there's a window, where the closet is, what shape the furniture is. Notice the smell of the room. Think of your memories from this room. What games did you play? What was it like to wake up in this room? Where did you draw pictures or just doodle? Pick up a toy or a book and play with it. Become the child you used to be.

"Now lie down on your back on the floor... Try to take it all in. Try to feel as small as you once did. Now stand up again and look around the room one more time. Go to the doorway and look in on your childhood as an adult. You're an adult standing there, looking at the figure of yourself as a little boy. He's sitting in the corner. Go to him and take a closer look. Picture him as best you can. You may even want to think of an old photograph from that age to strengthen the image. Now sit down beside him. Put an arm around him. Tell him, 'I'm here now,' and ask him what he's feeling. Ask him what he needs. Give him what he needs. Say all the comforting things you wanted to hear when you were a child but never did. Now pick him up in your arms and give him a big hug. Hold him close and say, 'You're a good son, and I am proud of you.' Take him out of the room into the bright, sunny day.

"Sit together in the grass for a bit and feel the warmth of the sun... Now imagine that you are taking him to a new, safe place inside of you. Imagine a soft, warm bed, and tuck him into bed right beside you. Sit down with him, and again say to him what he needs to hear. Now kiss him one more time, and hug him again. Now, he has a special place inside of you, so whenever he needs you, you'll be back. Say to him, "I'll be with you always." Tiptoe away from him and walk back into the hallway, up the staircase. When you're ready, open your eyes and join me again."

Consider your male client experiencing depression and shame you are currently treating. Would he benefit from this reparenting guided visualization? Would it be beneficial to play that portion of this CD in a session? If the musical tones were inserted easily, mark start and stop points when fast forwarding through this track on your CD player.

After this "Reparenting" exercise, it's important to ask your client how he feels. It may take him a few tries in this exercise to clearly see his child self or to peacefully talk to himself as a boy. But gradually, he may be able to chip away at the anger and shame he felt as a youngster.

In the next track, we will discuss how to recognize shame.

Peer-Reviewed Journal Article References:
Balcom, D., Call, E., & Pearlman, D. N. (2000). Eye movement desensitization and reprocessing treatment of internalized shame. Traumatology, 6(2), 69–83. 

DeLuca, J. S., Akouri-Shan, L., Jay, S. Y., Redman, S. L., Petti, E., Lucksted, A., Rouhakhtar, P. R., Klaunig, M. J., Edwards, S. M., Reeves, G. M., & Schiffman, J. (2021). Predictors of internalized mental health stigma in a help-seeking sample of youth: The roles of psychosis-spectrum symptoms and family functioning. Journal of Abnormal Psychology, 130(6), 587–593.

Johnson, A. (2006). Healing shame. The Humanistic Psychologist, 34(3), 223–242.

Legate, N., Weinstein, N., Ryan, W. S., DeHaan, C. R., & Ryan, R. M. (2019). Parental autonomy support predicts lower internalized homophobia and better psychological health indirectly through lower shame in lesbian, gay and bisexual adults. Stigma and Health, 4(4), 367–376.

Sherman, N. (2014). Recovering lost goodness: Shame, guilt, and self-empathy. Psychoanalytic Psychology, 31(2), 217–235.

Williamson, T. J., Ostroff, J. S., Haque, N., Martin, C. M., Hamann, H. A., Banerjee, S. C., & Shen, M. J. (2020). Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma. Stigma and Health, 5(4), 425–433.

Online Continuing Education QUESTION 4
What are two methods that facilitate healing internalized shame? To select and enter your answer go to CE Test.

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