Reducing one’s shame by using a non-pathologizing approach
By James Seymour, MD
Director, Trauma Recovery Program at Sierra Tucson
At Sierra Tucson, we provide what is referred to as Trauma-Informed Care for all of our residents. Trauma-Informed Care is the recognition by the treatment program and the clinical staff that a history of childhood trauma is very often associated with and underlies many of the challenges we see. This includes substance use disorder, depression, anxiety disorders, eating disorders, various impulse control disorders, and chronic pain. In addition, we recognize that childhood trauma affects how residents experience our therapeutic interventions.
The most common emotion that nearly all individuals with a history of childhood trauma experience is a deep, abiding sense of shame – the sense that there is something inherently wrong with or bad about them. So in a way, Trauma-Informed Care is simply shame reduction, and shame reduction is Trauma-Informed Care. We make sure that all our interventions work toward reducing shame rather than creating or worsening it.
How do we do this? First, we take a positive, non-pathologizing approach. We don’t call those we treat patients. We refer to them as residents. Post-traumatic stress disorder (PTSD) is not a disease or an illness but rather, a normal nervous system response to traumatic circumstances. Although our residents have serious symptoms and interpersonal problems, we like to stress that essentially they are normal individuals. There is nothing “wrong” with them. We take an approach that focuses on the resident’s strengths and resources, not on his or her weaknesses or difficulties. This goes a long way toward shame reduction.
Also, personality disorders are not labeled as such. What we see as clinicians is simply maladaptive behaviors that arose to deal with a highly dysregulated nervous system, which is often secondary to trauma. We are extremely careful about the language we use as language that makes a difference. An example would be that we don’t describe someone as manipulative. When we see that type of behavior, it is a strong clue that the individual has never had enough trust in a relationship to think that asking for help directly would be of any benefit. We do this with other words that are frequently used to label those we are trying to help.
At Sierra Tucson, we believe that helping reduce a resident’s shame is one of the most helpful and powerful things we can do.