When Shame Enters the Therapy Room with Dr Ruth Birkebaek (Mar. 2025)

We welcomed Dr Ruth Birkebaek back to Bramham Therapy to talk about shame in the therapy room which she did with her usual warmth and compassion.

She began by inviting us to imagine standing up and sharing something we have never spoken about before and to notice our feelings around this; what we might fear and also what we might want from everyone in the room. It was a powerful exercise, allowing us to connect with the impact of shame and the desire to keep it hidden and secret.

Ruth went on to explain that the origins of shame come from interpersonal relationships, resulting in humiliating behaviour from another person which then becomes internalised. We then hold the memory of this shame which, alongside the anticipation of shame, can be easily triggered both in relationship with others and in our own fantasy of ourselves in situations.

From there, Ruth invited us to look at how our attitudes as therapists and supervisors might trigger that memory of shame, for example the power dynamic in the therapeutic setting, competitiveness, dismissive attitude, our tone of voice or the arrogance of being ‘the expert’. She suggested that these traits may come from the therapist’s archaic need for validation and the desire to appear competent and the fear of failure. In order to compensate for these fears (possibly coming from the therapist’s own shame) the therapist may utilise behaviours such as grandiosity, intellectualisation, control or emotional withdrawal. She suggested that such distancing attitudes in a therapist or supervisor actually stem from a fear of being able to be vulnerable with our clients and can in turn trigger shame in our clients.

Ruth invited us to think of the therapeutic errors that might be part of this and that we might hide our own shame through such attitudes, instead of being non-defensive and open in our communication, which in turn helps to diffuse shame. It was really helpful to explore and consider the impact our own shame, as therapists and supervisors, and how this might impact the therapeutic relationship.

Ruth referenced to the 5 elements of shame that Richard Erskine highlights:-
Something is Wrong with Me. This refers to a core belief about oneself, which may present as ‘I can’t do it’, ‘I’m going to get it wrong’, or postponing things or often being ill.
Sadness. This is about not feeling accepted for ‘who I am’, that the core of my being is unacceptable.
Fear. This can be seen as a fear of rejection for ‘how I am’, ‘how I feel’, ‘how I think’ and can often present as ‘imposter syndrome’. There is the fear that if you really know how bad I am, you will reject me.
Compliance. This may present as accepting how you are defined by others, eg shy, and complying with that in order to be loved and accepted.
Anger. Ruth spoke about retroflexed anger or disavowal of anger, which presents as turning anger inwards instead of at the person who is humiliating you.

Ruth went on to consider ways of working with shame, citing the importance of valuing and validating the client, accepting them as they are and being alongside them in trying to understand why they feel as they do.

She focussed on the importance of working with the body, saying that shame is held in the lungs in particular, which can lead to difficult in speaking, with a sense of paralysis and shut down. If the therapist can help the client to gently notice what is happening and then invite the client to feel into their bodies, it can really help the client to connect body and mind and start to feel more grounded and safe.
She explained that as shame often comes from a very young part of the client it is helpful to try to engage compassionately with the source of the shame. Often the client cannot remember what happened, so she encouraged us to invite them to imagine how it might have been when they were very small and to always be thinking of the developmental age of the inner child in the room.

Ruth then demonstrated her way of working with shame with a live therapy session with one of the delegates who bravely volunteered to be the client. This was a wonderful opportunity for us to see her compassion and tenderness with the client, paying particular attention to the client’s bodily responses and deeply connecting with the child part of the client in the present tense.  It was a moving and informative session.

Ruth offered us some wonderful insights into working with shame. Her compassionate and warm approach ensured that we were able to learn a lot about the subject of shame in a gentle, unshaming and holding way.

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Average feedback scores from our event:

Organisation of event: 4.75 out of 5

Speaker: 4.8 out of 5

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Feedback from our event:

“I enjoyed all of the workshop including the live work and group work. Ruth is awesome – explains so well. The day was organised really well and so helpful to have directions and handouts beforehand” – Jane Taylor

“I found Ruth really insightful and so calm and reflective. The explorative nature of the day was so helpful rather than being bombarded from a therapy theory perspective” – Rachel Brant

“The content was new to me and very interesting and well presented. I loved the gentle delivery and the pace was good” – Sally, Newbury

“I particularly enjoyed the live therapy session. The workshop was another excellent group session” – Marie, Marlborough