Difference between shame and guilt

As you may have already gathered from my previous post, the meeting between friends from my university days have prompted many thoughts in me. Today, I received an email from one of my friends and I was surprised by the unease and resistance I felt towards some of the words he used. More specifically on words like ‘shallow’ and particularly on ‘shame’. I then realised that this is not the first time, ‘shame’ has come into our conversations.

The first time it was mentioned, was in relation to the common practice of continual financial support from ones’ parents, which in practice could go on almost indefinitely. He expressed that he doesn’t mind his girlfriend (wife now) using her parent’ money even after marriage to support daily spendings. Upon further discussion, I put across to my friend that I would like to be financially independent of my parents once I completed my doctorate. And that I have been plagued by guilt for some time now for relying on them for such an extended period of time. To this, he reacted strongly saying that he doesn’t think it is shameful for his wife to be using her parents’ money. I was taken back and immediately clarified that I am not judging her and it hasn’t crossed my mind to think about it as shameful. A debate ensured. He was unconvinced that I don’t think it is shameful. Putting some of my therapeutic skills into practice, I clarified that the word ‘shameful’ was a concept that he brought into our conversation. Whilst I can see how it could be seen as shameful having been brought up in an Eastern society myself, in this particular context, I felt guilt rather than shame towards my parents. We left it at that and I didn’t think anymore of it.

My partner and I have been talking about marriage for some time now and he recently proposed to me on a romantic hot air balloon flight and indulged me with a dreamlike engagement ring. In a conversation with this friend of mine, he felt that my partner’s actions have put him to shame, as he felt he did a very simple proposal. This time, I was very interested in the word ‘shame’ and could feel a strange resistance towards it. It also stood out for me as I haven’t heard this word for a very long time. Yes, we read about it in psychological literature and interestingly it is usually associated with the Eastern culture, furthermore in my personal experience of conversations with clients, course mates or colleagues the closest emotion/ concept that have been brought up is ‘embarrassment’. Shame is rarely mentioned.

Following this thread of thinking, I did some research online and found an abundance of journal articles on this. One in particular stood out for me- ‘Cultural Models of Shame and Guilt‘ by Ying Wong and Jeanne Tsai. According to a review of the literature carried out by them, there is a fundamental consensus that shame and guilt is a ‘moral’ emotion. Thus it is experienced when an individual perceived that they have done something wrong. Moreover, shame is experienced when one perceived that others have evaluated their actions to be wrong/bad, whereas guilt is experienced as a result of an internal evaluation when the individual him/herself perceived their action to be wrong/bad. All these made sense so far considering Eastern’s collectivist vs Western’s individualistic society. Moreover, the article went on to propose that guilt and shame are similar to each other and in collectivist cultures, the difference is less pronounced. Guilt and shame are often used together. In addition to that, guilt and shame are context dependent. Guilt is expressed when a general code of conduct has been violated whereas shame relates to situational context. Thus shame is a more appropriate emotion than guilt in some context. It has also been suggested that it is a valued emotion in non-Western cultures as a response to failures and prompts self-criticisms which drive individuals to success. This makes logical sense to me, but somehow, it’s still niggling me. For me, it sounds like a shame-induced self-motivation suggests that we are driven to success based on goals established in relation to others. Yes, we all exist in relation to the other, but the scale of balance between self and other is a delicate one. I have personally found living my life to familial and societal expectations a tiring one.

Its’ prevalence is well documented. Research (Li et al, 2004) found that there are 83 shame related terms in a Chinese dictionary and 113 shame related terms. This puts into perspective the salience of shame. It was also found that, parents in Chinese culture are more likely to use shaming techniques to educate. Moreover, research has found that shaming in American schools have harmful consequences for students whereas for students from collectivist cultures, it appears to be self-motivating (Reasoner, 1992). Thus Wong and Tsai (2007) proposed a cultural sensitive model to working with clients in psychotherapy, where eliminating shame and/or guilt may be counter productive.

Having lived in the UK for more than 10 years and perhaps due to nature of psychotherapeutic, perhaps I have become more individualistic in my way of thinking. On reflection, my resistance towards the concept of shame is perhaps due to its focus on the negative impact of others perception towards oneself. Perhaps having seen the devastating effect of stigma, which I find to be similar to the concept of shame, I am hesitating to endorse it. I remained unconvinced that it is productive although it inevitably exists and needs to be worked with. Perhaps, it is a matter of perspective and it an emotion that could be harnessed for positive self-development.

There’s such a thing as appropriate guilt, just as there is appropriate shame.  Being able to tolerate and not be overwhelmed by them is a sign of mental health. (Burgo, 2011)

A very interesting article and talk by Dr Brene Brown on shame, guilt and addiction.

Someone experiencing guilt will say to themselves, “That was a really stupid thing to do. I wasn’t thinking.” In contrast, someone experiencing shame will say, “I’m an idiot. I’m such a loser.” In other words, guilt focuses on behavior while shame focuses on self.

M

Reference

Burgo, J. The difference between guilt and shame. Accessed on 27th August 2013 at http://www.afterpsychotherapy.com/shame-and-guilt/

Li, J., Wang, Q., Fischer, K.W. (2004) The organisation of Chinese shame concepts. Cognition and Emotion 18, p767-797

Reasoner, R. (1992) Pro: You can bring help to failing students. What’s behind self esteem programs? Truth of Trickery? School of Administrator, 49 p 23-24, 26, 30

Wong, Y., Tsai, J. (2007) Cultural models of Shame and Guilt. In J.L. Tracy, R.W. Robins, & J.P. Tangney (Eds.) The self-conscious emotions: Theory and Research (pp 209-223). New York: Guilford Press

PPD: vehicle for self realisation or torture?

The concept of Personal and Professional Development Group (PPD) was not entirely new to me when I first started this course. I had a similar experience back then when studying for my masters, although that was for a shorter period of time each week. The PPD group I’m in now is for 1 and half hour and as far as I know, it seems like PsychD courses in other universities have similar groups although it may be smaller in terms of number of people in the group. For those who are uncertain what a PPD group is, basically, it’s a group where you are free to say whatever you want and bring whatever issues that you want to address, in a group that is. The idea is that the dynamics in a group is different from say one to one and obviously the people in the group are individuals in their own right with their own ideals and expectations. Therefore what you may get to experience is an array of responses to what you bring and hopefully that will help you in your personal and professional development.

Sounds pretty straightforward right?

Easier said than done.

Without compromising the confidentiality of the group I am currently in, the only thing I can say is that, be prepared to be challenged- at a personal level. Scary, but I suppose better out than in. It’s a good place to experiment your responses as well.

A thought though, why is a group needed if a challenge is to be made at a personal level to a specific someone? Is there a cultural difference where social niceties are more prevalent here and therefore a boundaried space is needed to say things that you wouldn’t normally say due to social constraints? Thinking about where I come from, I suppose we have been known as ‘rude’, because one just address things in a more direct manner between peers.

M

Is it doable? Yes it is!

Congratulations to A for having a smooth year in terms of academic work and for progressing into 2nd year! Well done! You most certainly have been doing the right things, keep it up!

I’m pleased to say that I am allowed to progress into 2nd year too with a condition of resubmitting my process report and sitting for viva before July 2013! So, it’s not all too bad. But this will mean that I will have to draw from A’s self discipline as I will have an extra 2 piece of work to prepare in year 2 on top of the hefty amount of assignments and impossible deadlines we have. I count 7 assignments, in the space of 9 months, not too bad, about 1 a month not including the 3 day placement and placement related activities – actually does sound like a lot doesn’t it especially including the 2 extra piece of work I have to resubmit, makes it 9! Woohooo!!! Woohooo!!!! This feels like… I feel like I’m starting to float… losing my mind. Ok, KEEP CALM (funnily, I bought a colleague of mine the Keep Calm and Carry On mug, maybe I should get one too). Well, to be fair, we had 9 assignments on our 1st year and what more it’s the 1st year where everything is new and you feel absolutely deskilled. So, if that can be ploughed through, this can be. Hoohaaa! Power!

The point I’m trying to make here is that, somehow it is a common misconception that a doctorate is not difficult, one just has to write a piece of research, attend a few lectures here and there and ta da! you’re a doctor. But let me tell you that is not true for a PsychD, apply for this doctorate with a realistic view that you must be prepared to sweat it- blood and tears and trust in delayed gratification (pay-wise). But the immediate reward of self development and satisfaction is immense.

M.

The sob story- What did I do wrong?

I think the fundamental thing that I did wrong on this assignment was that I had not done a thorough assessment and this affected the quality of my psychological formulation. A weak assessment does not provide a good background history for the marker/reader. In retrospect, this is perhaps my biggest struggle especially at the beginning of my counselling work. How much do we need to know about the client for therapy to work? Also, with a non-directive approach such as person centred, how do one then ‘question’ the client about their past? From a counselling perspective, if we are working on the current issues that clients bring, why do we need a detailed background history of the client? Why do we need to chart their childhood and adolescent relationships? Why are these relationships then used to produce a formulation of the client? Why doesn’t the formulation just describe how the client presented him/herself in therapy, what was worked on, what could be different and why.

In my defence, I had sought for these questions to be answered but perhaps due to my trainee status I was told that I was being too anxious (which I was, more so when I don’t know how to marry practice with professional requirements), uncomfortable with the non-directive nature of therapy, trying too hard, just need the therapy to be etc…  however I was also told that I should make my own assessments which was a very useful piece of advice. Now, why hadn’t I thought about this before? At the beginning of the year, I got a sense that one has to be qualified or experienced to make an assessment of the client after hearing from my colleagues how they shadow qualified practitioners while they make assessments or that they were simply provided with case notes that contain client background information. However, after recent discussions with my colleagues and reflection, I now know that being informed about their past allows for much greater depth in my understanding of the client. It puts the issues presented by clients into a wider social context where the interaction between the self and environment can be examined. This in turn allows for a more holistic therapeutic intervention and perhaps epitomise the idea of an idiosyncratic approach that prioritise subjective experience of individuals.

Having said all that, I think that there is another reason to the disappointing results I got – emotions or more accurately not communicating enough personal feelings about the client. A story for another time. :)

M.

Poster presentation?

So, my research supervisor just emailed me and ‘asked me’ if I have the time and whether I would be able to come up with a draft poster (based on a piece of literature review I wrote as part of the course) for a conference in November. My answer? Hell ya!

I know I’m all geeky but this is exciting news! Boosts my confidence again after the failing of one of my other assignment (story for another time, a loong sob story). Life is all about ups and downs- momentary ones at that too.

M.

A psychologist’s holiday

So what does a psychologist do on her holiday? Taking on the theme from the previous post, when does the holiday begins and when does it end? Do we ever stop analysing the world around us, applying theories to others’ plight, processing the deeper meanings behind people’s words, making hypothesis of ones’ developmental journey etc… Do we ever let our mind rest? Or is it so ingrained and so part of our being that we just can’t stop! Well, to be honest, I can’t. Even more so during holidays! I tell myself I have so much more time on my hand and this is the time to put to practice what I have learnt to see if I have achieved any self development. To push myself that bit further, challenge my insecurities and boundaries.

I was at a dinner gathering few weeks ago, and a friend asked me – ‘would you refer on a client whom you think you can’t work with?’ and that question dumbfounded me for few seconds. That is a question that have been asked many times over in interviews or in social occasions, but somehow my answer changes every time. At first I would talk about which kind of clients I think I can’t work with due to my own personal issues with the matter they bring. But having recently read Yalom’s ‘Love Executioner and Other Tales of Psychotherapy’, I wondered if there are truly anything that we can’t work with and whether it is a matter of us not wanting to work with it. Yalom found the idea of obesity repelled him, which he acknowledged at first instance but decided to take on the female client nonetheless. It is indeed admirable that he decided to challenge himself and understand more of his personal issues with obesity by learning from this client- empathising with her struggles and finally seeing the woman who desires to be loved like everyone else working hard towards achieving this goal. His own issues with obesity also helped the client to understand how others are perceiving her which highlights for me the the notion of bringing one self into the consulting room.

It is this torn between being me and being an understanding therapist that I have struggled with. Unconditional Positive Regard (Rogers, 1961) can be offered at first instance, but sometimes it does not come as easily as one thinks. Nonetheless, I believe we are equipped to delve deeper on why that is not the case with some clients.

Hm.. someone remind me I’m on holiday again please.

M.

Some of the books I have referenced here are:

1. Love’s Executioner and Other Tales of Psychotherapy by Yalom, I.D. (1991)

2. On Becoming a Person: A therapist’s view of psychotherapy. by Rogers, C.R. (1961)

Welcome A!

Welcome A to this blog, A writes with abundant eloquence and thoughtfulness. I’m very much looking forward to reading your posts!! So excited to have you here!

M

Half a year ago…

Hello, time does flies doesn’t it, half a year has gone by without an update. What does that say about this life as a c.p trainee? Half a year… that’s a pretty long time. Felt like so much have been learnt, so much have changed. This course really call for one to deconstruct and examine oneself inside out. Bear the unbearable but assess why they are unbearable. Bring down your defences, examine them, and put them back on if they still suit you. Puts blaming and self-justification in a different perspective huh.

Toiling away my literature review assignment at the moment, one of the biggest piece of work for the year and forms the first part of a three year project. Got my first draft back, lots to change– needa write in a more scientific language, more numbers- statistics, more critiques on methodology and the use of Randomised Controlled Trials as evidence for treatment efficacies… Thought of the day: Drafting and redrafting to allow for analysis to develop and understanding to deepen (my optimistic thinking).

Doctors and death

While I was watching a movie yesterday, a thought struck me.

In one of the scenes, the protagonist’s best friend who have been battling with drugs and disease, which eventually lead to an embarrassingly display of public incontinence attempted suicide. He was rushed to the hospital and was fighting for his life. It seemed to me, the whole scene was play backed at a slower rate than normal. The urgency of the doctor was illustrated in detailed with the hurried push of the stretcher, seemingly futile CPR, repeated defibrillating, unresponsive heart rate monitor, and finally the pronounce of time of death. She then slowly pulled up the blanket up and covered the deceased’s face. After telling the family members and friends that she had done her best, she walked away briskly.

As I watched this scene, I wondered,what if, that is the doctor’s first time pronouncing? Or even if it’s the 3rd or 4th or 5th time? How does the doctor feel at that moment?

With this curiosity in mind, I scoured the web, blogs and scholar (I used google) with key words such as ‘doctors pronouncing time of death stress’ which yielded some results on how to increase sensitivity while performing it, and one that gave a glimpse of self development from pronouncing death but unfortunately I have to pay to access the article but other than that, it doesn’t seem to be a case. So I made it less specific by entering key words, ‘doctors time of death’, ‘doctors stress’ and ‘doctors pronouncing’. I was pleasantly surprised that it doesn’t yield any narrative results whereby a doctor talked about their experience nor any research studies showing how they manage it or even suggest that this might be a cause of stress! Does this mean that doctors manage them quite well that it does not justify the need to be documented or researched?

I simply cannot imagine myself being fine facing the first death of my life which I have to make ‘official’. Would I be fine watching the heart retching sobs of family members and friends? The lost of a life? How should I prep myself to be professional? It almost seems that I am required to be empathic and strong right from the beginning of my medical career.

As a counsellor, I would not be facing direct death at work so I cannot understand how that feels. Bereavement for a client would be a completely different situation as they have emotional ties to the deceased. How would I feel if a stranger passes away in front of me? I would be tremendously shocked and feel immensely sorry for his/her loved ones but I guess it is but a passing moment for me. Perhaps this is how doctors see it…?

Placement update and End of MSc!!

As you know, I didn’t succeed at the first placement interview so I emailed the course secretary at my university  to ask her if it’s possible to get an interview at a different place. Well, guess what they replied me with details of another Children and Young People Service Centre! This time they were specific that the centre has agreed to accept a first year trainee. This news revived my excitement! I’m so glad I am able to have another go at trying out for CAMHS. I will try my best and hope that I get it.

Anyhow, I handed in my dissertation today!!!! Finito! Another degree K.O! (not like I’m planning to do loads of degrees). In the end I cut it down to about 14.5k words but packed full of my hard work and dedication for the past few months. I am so proud of myself.

It had been one eventful morning which consists of me waiting patiently for a printing shop to open, pacing about waiting for them to finish printing and binding and handing it in! And what a lovely surprised I had when I bumped into few of my course mates. Followed by lunch with an ex course mate of mine which is going on to do Clinical Psychology. We talked about some of the differences and similarities between Counselling and Clinical Psychology. She doesn’t think there are many differences except maybe the Clinical Psychologist Trainees get paid while we don’t! Anyhow, Great stuff! It was just absolutely delightful to catch up with them before I leave for England next week. Next week! One more month to the start of my professional training in Counselling Psychology. To put it in a cliche way: The end to all beginnings. Finally, I got into something that I have been working towards. All those jobs here and there in counselling centres, support work, charities, research paid off. It has been a truly outstanding experience.

By the way, for anyone who are interested, the abstract for my dissertation is as follow:

Tittle: Vicarious Traumatisation Revisited: Capacity for Growthful Experience for Therapists Working with Traumatised Children and Young People

ABSTRACT

It has been well documented that work with these client groups is hazardous in nature and therapists could potentially experience a change in previous memory and schema as a result of this exposure (vicarious traumatisation). Moreover, growth following adversity has been displayed in survivors of trauma (posttraumatic growth). This dissertation aims to bridge the gap between these two phenomena in an effort to explore the personal development of therapists as a result of negative emotional demands. This is done through obtaining rich descriptive accounts from counsellors and psychotherapists. The interviews showed that it is difficult not to acknowledge the phenomenal role personal values and beliefs plays in counsellors and psychotherapists process towards achieving growth. Also, analyses of the interviews found that they were more aware of the real world and this comes with the notion of uncontrollable circumstances, realising that children and young people are extremely resilient which encourages hope and that they gain personal growth from observing client’s growth. They appeared to have rearranged their previous schemas to accommodate the knowledge they acquired through work with traumatised children and young people.

 

 

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