Professional website of Avi Soudack

Mental Note

Musings on therapy and psychological health by Avi Soudack, RP

Don't Let Shame Get in Your Way

May 2023

Have you ever been so ashamed about something you've done or said or thought that you avoided talking about it with anyone? Not even your therapist?

Even in good relationships, with people close to you, you may omit or change a story because of the shame you feel. So, it's understandable that you might do that when working with a therapist. Research suggests that two-thirds of clients leave things out during psychotherapy. People often find it difficult to talk about relationship difficulties, sexual issues, or feelings of failure. And, of course, their therapists don't know what has been left unsaid. Unfortunately, that obscures an important part of who they are and can impede their progress in therapy.

Shame, Guilt, and Embarrassment

Shame is a powerful force with deep roots in our species history and in every childhood. When we feel ashamed we become so self-conscious that we are immobilized, unable to think clearly or act normally. In pre-historic times, shame helped keep social groups cohesive and safe — anyone breaking the rules was shamed. Shame disciplines because it so painful an emotion that we try to avoid it at all costs. Today, children are often shamed as a way to get them to conform to parents' or institutions’ expectations, and social groups ensure conformity by shaming transgressors. Shame is not the same as guilt. Here's the difference: Guilt is feeling that you did something bad. Shame is feeling that YOU are bad. In contrast to guilt, which is associated with behaviour, shame is associated with your self. That's one reason shame is so painful: it is closely wrapped up with your sense of self-worth. And don't confuse shame with embarrassment. You might be embarrassed because you dropped a plate of food on the floor at a party. But the experience is usually fleeting. You may have looked silly, but others have too, and it's soon forgotten. Shame is deeper. When you cannot shake the feeling, when you feel, not that you looked silly for a moment, but that you are bad or worthless — that is the deep, debilitating emotion of shame.

Shame in Therapy

Shame shows up in therapy in many ways. When revealing things about yourself, you'll inevitably have thoughts, feelings, and memories that you are ashamed of. Therapists recognize that those are hard to talk about. Some people are more prone to shame than others, possibly after having been shamed excessively during childhood. Such deeply internalized, pervasive fear of shame may express itself in indirect ways — a person may becoming controlling and aggressively shame others to mask their own insecurity, or become a perfectionist to avoid any chance of feeling shame again. Tragically, trauma can manifest itself in shame as the victim takes the blame and the shame for the behaviour of others on themselves. And shame may be linked to anxiety, as someone who is shame-prone approaches much of their life in fear of being shamed.

Just as it might be hard for you to talk about things you are ashamed of, it can be hard for a therapist to get at a client's shameful thoughts. No one likes to cause pain to others and exposing shameful thoughts is certainly painful. So therapists may avoid asking about or probing on some issues.

Getting the Most from Therapy by Opening Up

But ultimately, it's best for you and for the course of your therapy if you accept and examine sources of shame. There is evidence that when clients don't talk about things that are important to them, the outcome of the therapy is not as positive. On the other hand, when client and therapist bring shameful thoughts out into the open, there is great potential for healing. Simply expressing shame can often be therapeutic in itself. Acknowledging that it is normal to feel shame can bring real relief. Gaining insight into its origins and triggers leads to self-acceptance and practical coping techniques to manage shame.

One thing we know for certain is that a solid, trusting relationship between therapist and client is the key to successful therapy. Hiding shameful thoughts during therapy can damage that crucial connection. But opening up about those painful feelings only strengthens the bond and encourages healthy transformation.


Dearing, Ronda & Tangney, June. (2011). Shame in the Therapy Hour. American Psychological Society.

Farber, B. A. (2003). Patient Self-Disclosure: A Review of the Research. Journal of Clinical Psychology, 59(5), 589–600.