Shame Resilience for Social Workers

These are my notes of what I wanted to present at the Alberta College of Social Workers Conference Mar 27, 2020. 

Thanks for that (the intro) or the name of the person.

Welcome everyone. I am SO happy and excited to be here. I love being in a room of social workers and crazy enough I love talking about shame resilience- I do it a lot. I am in private practice as Clinical Social Worker and shame resilience is central to my counseling philosophy and lens. Shame gets in the way for a lot of us and makes it harder for us to understand what’s really happening underneath it—our feelings; where our boundaries are and so on. We need to strip away that first layer of shame to make our way on other issues… and actually truth be told, I just think of shame as a bull shit liar—because no matter what, we are all worthy of love and belonging. And we’ll get to all that.

I’ll just tell you a little about me… well because when I’m in a workshop I like to know who’s talking. I came up through social work. At 19 years old (untrained, clearly) I drove kids and supervised parental visits on contract with Children’s Services- I don’t know why anyone let me do that. Then I worked in group care with adults with developmental delays while in university and group care with youth between degrees- in the city with McMan and the old Bosco ranch. I worked in Children’s services as a case manager and then studied the admin and evaluation side of social work at University of Manitoba looking at the integration of services for high risk kids across ministries. 

Then I spent a decade raising kids and working in reproductive health before going back to studying to bring up my credentials to become as Clinical Social Worker. I’ve been in private practice since 2012—growing my practice while under the supervision of now my friend Karen Nielsen- social worker extraordinaire. [Who would have been in the audience and gone for lunch with me after.] :-(

The origin of this talk came about 2 years ago when I was asked by Leanne Hilsen at the University of Calgary, Edmonton Division to talk at the BSW Field Supervisors’ lunch. I’ve always been a big Brene Brown fan from the first viral TED talk in 2011 and Leanne knew that from my professional social media. And then Leanne told me about this very cool social worker from Vancouver named Vikki Reynolds. And here we are two full circles around the sun later and I spent the day in a workshop with Vikki Renyolds yesterday and heard her speak this morning and I am here talking on the same topic to you great people. [which of course didn't actually happen. FC!]  

__________  

So now I want to get an idea of the social workers (both trained and untrained—some of my best friends are people who were born to be social workers and never did get the university training).

1   Who works directly with clients’ most of their time?

2   Who has been in the social work field for 1-5 years, including students; 5-10 years? More than 10 years?

3   Okay and where do we work? Large cities- Edmonton, Calgary, Red Deer/ Lethbridge?

4   Who works in town settings?

5   And primarily rural settings?

6   And where do you go to work everyday? Hospitals and Health care settings? Schools and universities? Children services? Government social services- city, other provincial programs, federal? Non-profit agencies? Community social workers? Urban Core Neighborhoods? What else do we call that—front lines, in the trenches?

What have I missed?

And then “client issues”  (and I’m using that word because we have to have a way of talking together today, but I don’t see it as us and them- because that’s a false binary set up in the professionalization of the work and it’s distancing by its nature. It’s also false to think that social workers don’t have similar experiences as “clients” or are never “clients”.)

Who works with people experiencing: 

Poverty- income instability; food insecurity; housing insecurity or homelessness?

Mental illness including severe and persistent mental illness?

Clients with a physical disability? Chronic Health Issue?

Criminal justice involvement?

Clients who struggle with one or more addiction.

Sexually exploited now or in the past?

Suffered from multiple adverse childhood events including abuse, neglect or witnessing parents with an addiction, violence between them or other issues like metal health/ criminal involvement or addictions?

Client’s who struggle with systemic discrimination and oppression related to sex, race, gender identity, sexuality, ability, income and socio-economic status.

And is it fair to say that you all know who Brene Brown is? Our famous colleague—a social worker from the University of Huston. She is a shame and vulnerability researcher. She has a viral TED-X talk from 2010 and in 2012 she presented at our ACSW conference in Edmonton. I’m a big fan. I was there at 7:30am and got my picture taken with her. She’s written 6 books- most are best sellers and she hangs out with Oprah now and has a Netflix special. And as of last week has a great podcast called Unlocking Us. 

So today I want to use some of her ideas about shame and vulnerability and how we rise up when we struggle, fall or fail—and apply them to the work we do as social workers.

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As social workers we know that everyone has a story and in fact, a lot of what we do is sit with people and listen to their story…. Where they have some from, where they are now and what they might need to move forward in their own story.

And the stories we hear are most often are stories of struggle and striving. And as social workers the people we listen TO and work alongside OF, are those who are marginalized from mainstream society—who often live with systemic discrimination and oppression.

And I want to acknowledge that many social workers live in this same way—with their own experiences of systemic discrimination and oppression. There really is NO us-and-them, but in a work context we take on the role of social worker and for simplicity the person we are working with will be a “client” in the way we talk today.

So our work is messy people caring work and it’s often in a context that is filled with social injustice. We have the people we work with and the context of their lives, their lived experiences, their story and we have us—each of us as an individual—and the context of our life, our lived experience, our story.

So before I go into how hard our work can be and how natural it is that sometimes we struggle or have difficult responses to our work, let’s first just orient to our own story as it relates to social work.

Ok, so a little housekeeping…. you’ll need a pen and something to write on and you’ll also need a sharing partner for these next 3 little exercises. Please pick someone you don’t know or don’t know very well. Not your best friend you came in with and not someone you will see at work Monday morning. And can you do a quick intro with each other, please? Name, where you’re from or where you work.

I work dyadically most of the time and so I lean towards the sharing in pairs over other formats for reflection or sharing. Great! You’re all great!

Coming into your own story-- I want you to think about a couple of positive qualities that you had as a child. How adults would have described you when you were a little child—USING POSITIVE TERMS- think age 7, 8, 9, 10, 11—in there. How would the adults at home or school describe what you were like. Take a minute to jot that down. And now share that with your sharing partner.

Okay and now take a minute to think about how those childhood qualities are potentially the gifts that you bring to your work. And consider that these qualities (even if they weren’t appreciated when you were little) are the gifts you share in your best social working moments.  Consider how they connect for a minute--- And when you’re ready, share that with your sharing partner.

AND NOW: come back again. I want you to think about a recent positive interaction with a client. Is there are highlight in the last week or month of being with a client when you felt really good about it? What made it positive for you? Did you feel a sense of connection? Did you feel a sense of shared humanity or deep compassion for the client’s feelings or for their situation? Were you in awe of their ability to get through their hard times? Their resilience or tenacity to keep going? Perhaps talking with a client helped you put something in your life in perspective?

So the purpose of that is just to orient into yourself and how that’s related to your professional role. It’s meant to be grounding into what we all love most about our work and to remind us that what sets us up to fall or fail, is often NOT our direct work with clients alone. And if you haven’t heard Vikki say this already, she writes that most of use would say our interactions with clients are actually challenging, inspiring and even transforming for us.

So now I want to talk about what it feels like when we fall, we fail and we struggle. You might have an experience to draw on—when you didn’t feel like a “good social worker”- maybe in a conversation with a client or a co-worker/ supervisor or maybe just at the end of the day when you got home and had a feeling of not being able to do it.

In Brene Brown’s work, she says that the physics of vulnerability is such that if we are brave enough often enough, we will fall. Its not IF we fall it’s when.

And social workers, by our nature and our call to the profession is that we are people who strive to live with an open heart—with what Brene Brown calls ordinary courage—Ordinary courage is the ability to speak your mind with your heart—to tell your whole story with your whole heart and that includes the part of the story that has struggle in it.

Shame is about the times when we don’t feel worthy of love and belonging, and we hide a part of our story instead of stepping into the vulnerability it takes to own stories of struggle.

Shame is the feeling of being seen as failing or falling. Shame in part is a feeling like we are powerless—that is that we can’t make change happen—and as social workers (and this would be true of other helping professionals as well) we are very hard on ourselves when we fail, fall and struggle.  We don’t like a feeling that we can’t make change happen.

We know or we believe that when the people we work with struggle we will be there with compassion and empathy, but when we struggle, typically we are not as forgiving with our own selves.

And if you’ve ever heard Brene Brown say: you can only be as empathetic to others as you have compassion for yourself, as a social worker you probably thought, that’s a lie.  I’m very good at showing up for others, I’m just hard on myself. But what we know, is that if we don’t practice self-compassion, we are not able to show up emphatically. In fact, we risk thinking in us and them terms—there are people who need help and there are people who do the helping—and remember we already said that’s not only unnecessarily distancing and relationship damaging, it’s actually threatens how we hold our personal values and professional ethics.

Courage, compassion, connection help us to overcome experiences of shame. Empathy is the antidote to shame and even if as a group we are good at doing it for others we have to work on how we cultivate self-compassion. If we don’t, we will stay isolated and insulated from connection—and then shame grows.

So a couple of quick things about shame:

Shame is different from guilt. Guilt is I made a mistake and I should make amends. I step on your foot, I have some guilt- I’m sorry are you okay? Guilt is healthy and adaptive in relationships. Shame is different. Shame is the feeling that I am a mistake. There is something wrong with me. I’m not good enough.

The three things about shame: we all have it, we all hate talking about it, the less we talk about it the more it affects us.

Shame is organized differently for men and women, but it feels the same in our body. (quick side note- it’s not as gendered as this- but for the bulk of each gender there are differences that emerged from Brene Brown's original research)—most often for women shame is a web of competing conflicting expectations and a feeling of not being able to meet all the expectations. For men, Brene Brown (and others) talk about it as a box- with a limited definition of masculinity—where if you express emotion or vulnerability, you are weak. I appreciate that one may be more based in feminine ideals and masculine ideals, but I have definitely met men who struggle with competing expectations and women who were raised to see vulnerability as weakness—especially in masculine-feeling organizational settings. So let’s say its feminine/ masculine ways of organizing shame and not necessarily men and women per se.

And in the original research Brene Brown found there are 12 different categories where we can feel shame—today we are focusing on one- related to work. Some of the other 12 areas include: appearance and body image; past trauma; being labelled and stereotyped; family of origin; mothering/ fathering; physical and mental illness, including addiction. Some of these, like mothering or trauma can be minefields of shame triggers.

You’re all with me--- ok, breathe. Just talking about shame can be inherently shame triggering, but we’re going to move through it together.

That’s what shame resilience is: the capacity to recognize shame when we experience it and move through it in a constructive way that allows us to maintain our authenticity and grow from our experiences.

These are the 4 steps to shame resilience:

1.     Recognizing shame triggers

2.     Practicing critical awareness

3.     Reaching out

4.     Calling shame by its name

So first we have to recognize our shame triggers and we have to know what shame looks like or feels like for us, individually. Often our first response to shame is involuntary and it happens in a millisecond- our brain tells us to either freeze, runaway or fight and defend. In social circumstances, that means we will move away, move toward or move against. These are shame screens- it’s what we do to hide our shame and distract others from seeing it.

Moving away is withdrawing and being secret and silent about the experience. We are likely to go numb out with food, wine or beer, shopping, on-line games or social media….

Moving toward is when we are hustling to people please the people we are with—we do this so that we can still feel as though we belong to them. Hard core people pleasing isn’t something social workers would know much about (Haha).

And moving against is when we take the uncomfortable feeling of shame and discharge it outward into blame. We try to gain power over others by being aggressive or trying to control the situation (and we often reserve this one for the people we love the most).

So if we can catch ourselves in a reaction like this, those millisecond shame screens and we can stop and say—ahhh…. Here is a shame trigger. If we can get curious about what’s going on (emotionally, in our bodies and in our thoughts) it’s like collecting data about ourselves. If we can understand ourselves better, we can grow toward our wholeness. And to do this, we need to be able to hold self-compassion—otherwise we just shame spiral. Or if that’s a hard word to hold on to, simply self-acceptance. SEE my self struggling, acting out, withdrawing and on the other side, hold some self-acceptance and self-compassion—ahh, there I am being a messy imperfect human.

Shame triggers are often related to unwanted identities relative to our idealized identities. This applies to any of the shame trigger areas- my desired identities in how I want others to see me or how I want to see myself—as a mother, in my appearance, in my mental health… and we are using work here.

So lets see if we can do this as a large group—what are our idealized identities as social workers… how do we want to see ourselves?

When I think of us as a collective group, I think some our desired identities include: Being tough- we can handle it; we are resilient and can bounce back; we are also empathetic, we can help,  we can make change happen. And we are professional. We are able to talk about our clients and their experiences with a bit of emotional distance.

What are the unwanted identities?

I think they include being seen as weak, affected by our work; not able to handle it, judgmental (or non-empathetic), CAN’T make change happen, powerless, too emotional, too attached, NOT rational in the way we communicate.

Unwanted identities dictate our behavior every day. They do this because we work hard to show only the desired identities and then we don’t share what’s going on behind that.

But it’s worth it to figure out these desired and unwanted identities because the perceptions we have and how we want to avoid them are totally unrealistic and they give us little room to be messy imperfect humans.

That’s one step in shame resilience—recognizing shame triggers.

Another step is practicing critical awareness. That’s when we step back to see the context of our experiences. So Brene Brown has a few questions related to critical awareness that can be applied to any of the shame triggers areas—but I when I thought about them in how they apply to us as social workers, I was blown away.

What are the social or community expectations regarding this issue?

So thinking about the expectations that we have on ourselves or others have on is in our desired identities- tough, resilient, empathetic, but have some professional distance. Able to make change happen and get things done.

And expectations that we do more with less; do the impossible.

We aren’t asked what we need or what resources our clients’ need, but get things done.

Who sets these expectations?

They are political and complex- connected to the government and funding. The expectations are related to how society and the media understands (or doesn’t understand or doesn’t even know about) the social issue in the areas where we work… and of course, the social issues themselves are complex.

Who benefits from these experiences?

That social workers are tough and resilient… our employers. The government. The people who want us to do more with less. The people who wan to live with their privilege in action of never knowing how challenging and unfair some people’s lives are. Those who don’t want to think about complex social issues because they think someone else can do that- that person has a social worker—they are fine.

When we work with marginalized groups of people related to complex social issues, they are not really understood. People understand the context of nurses and hospitals and health care funding and will talk about that; or about teachers and schools, but when it comes to talking about complex social problems and the people affected by them, Joe Public doesn’t necessarily understand that. And so, often there aren’t a lot of people in the conversations related to the areas where we work. And they benefit by not having to personally address that there are some very big injustices in our society We aren’t just the “good Canadians” that have universal health care.

And this dynamic further contributes to the feelings of isolation—we are the advocates in our area of work and others look at us, like why is that a problem? That doesn’t affect me.

(things like systemic racism or child maltreatment or prostitution or the criminal justice system… that isn’t about them).

Are these expectations realistic? Do they conflict with each other?

No, they are not realistic and yes, they do conflict with each other.

Does it make sense that we can always be tough and resilient when we are also called to be present and empathetic with a client’s life circumstances? How do we do our work with sensitivity to the social injustice and then always stay non-emotional in our advocacy?

When we think of these critical awareness questions about the times when we struggle, we must understand the context of our work—that’s the task—broaden the lens that we are using to look back on the times when we struggle or fall…

We work in organizations without sufficient resources to address the social problem areas where we work;

There simply isn’t enough of us to go around’

We often aren’t part of decision-making that takes place 4 steps above our pay grade and it affects us and our clients.

We are often subject to organizational change and restructuring without input…because the systems we work in are political and affected by the politics of the day and funding and so on.

We work with some of the most complex social issues: homelessness, poverty, systemic racism, trauma, child maltreatment, mental illness, aging, and many more… and we work with people from vulnerable populations: Indigenous Canadians, new Canadians, people marginalized through sexuality and gender, people who live with chronic disease and disability…

So when I was working on all of this.. what came to me was this moment: So when we are tired and feel like “I’m not a good enough social worker”, why on God’s green earth (as my mother would say) do we hold that experiences as an individual pathology? What’s wrong with me? I’m not good enough. I can’t do this. I’m not normal.

So critical awareness is a practice of reality checking expectations. We need to contextualize our personal experiences and see how the larger political, economic and social forces shape those experiences and we need to normalize—other social workers feel this too. If we don’t we will further isolate ourselves or act-out.

The critical awareness piece tells us: I am, you are, we are: messy imperfect humans trying to get through some through some tough work on some tough days with competing and conflicting expectations about what we’re supposed to do and how we’re supposed to do that.

So we need to demystify the experience of shame around our role as social workers. That means we talk about it, share what we know with others and we learn more about it. If we don’t demystify the idealized identities, then we reinforce shame connected to the unrealistic expectations and continue to make exhaustion or burning out an individual pathology.

Part of demystifying idealized identities and this comes from Vikki Reynolds work is to talk about doable job descriptions and cultivating a workplace that allows for sustainability. What would it be like if there was a workplace expectation that you take an hour for lunch every day. Or there was a walking club promoted by your boss or a clinical support circle that was supported or paid for by your employer.

So leads to step 3 which is Reaching our to tell our story. (breathe) [my note to self. lol.] 

We heal shame in our connection to others. We know how to show up for our clients, but we typically aren’t great at reaching our. And if we don’t share our own stories of struggle, we wind up feeling separated from others and insulated from connection. We have to create safe spaces for those honest conversations.

When we fall, fail and struggle as social workers and that can include working against our professional ethics or our personal values either because the political structures around our work cause that OR because we make a mistake (I know, imagine social workers make mistakes….) There are some very good, but sticky conversations about how we work with clients, how people in our organizations talk about clients and whether that fits with our collective ethics (which is Vikki Reynolds work).

So what are the barriers to reaching out?

One is a sense of otherness: social workers re great at thinking our work is special. If we think our area of work is special—we think we can’t have these conversations with outside others. For example, people who work in the core neighborhoods thinking people who work outside of that don’t get it; people who work in hospitals close to critical illness, dying and death; or people who work with child trauma and abuse. We set ourselves up for insulating and think others can’t understand. It leads to working in silos.

That’s the other thing that is a barrier to reaching out—we often work in places that have a culture of scarcity. There isn’t enough of what we need… we talk about how big were the crises and how frequent and in some work places self-neglect is a badge of honor: I didn’t even have time to eat lunch. I didn’t even have time to pee.

This further reinforces the idealized identities and doesn’t provide a space for shame resilience (or for sustainability in our work).

We need to work to shit our workplace culture so that there is room for these things. We need to deconstruct work experiences of crises and talk through difficult ethical issues as they arise.

We reach out to others to help with the reality check, have honest conversations that have space for empathy through the falling and rising process. We meet to talk about our struggles—this feeling I’m not a good social worker—and also with accountability to our ethics and our collective way of understanding our work.

And so that’s the 4^th step- speaking shame. It can be hard to define or describe the feeling sometimes—because shame is a unique pain—but to speak shame means that we can talk openly about our feelings and our needs.

So when we have had a hard day and we might not recognize it, but there is a little shame edge to how we are feeling, we go home and make the people closest to us guess at what we need and then we blame them if we didn’t get it right.

If you don’t ask for what you need, you will have to act out or shut down. You don’t have a choice, you aren’t getting your needs met.

And this often leads to making us feel worse and we get into that shame shit storm. So we have to be able to speak our feeling and needs related to shame, yes, but related to it all.

Really, to be able to say this is how I am feeling, and this is what I need means that we see ourselves as worthy of having those feelings understood and those needs met.

So that’s shame resilience: the capacity to recognize shame when we experience it and move through it in a constructive way that allows us to maintain our authenticity and grow from our experiences.

So to wrap-up. Shame is the study of both the power of connection and dangers of disconnection. We need to find ways to emphatically support one another when we trip on shame triggers, fall, fail and struggle-- When we re not resilient or tough or when we make mistakes or have tough ethical issues to deal with.

As Brene Brown says, it’s being able to walk into our own stories of struggle—getting curious about feelings and the associated thoughts and behaviors that help us to own our story. I’ll end with a couple of Brene Brown quotes and then we’ll open it up for the minutes we have left.

“The irony is that we attempt to disown our difficult stories to appear more whole or more acceptable, BUT our wholeness and even our wholeheartedness actually depends on the integration of ALL our experiences, including the falls.”

And then I was going to read out Brene Brown's Manifesto of the Brave and Brokenhearted: 

There is no greater threat to the critics 

and cynics and fear-mongers 

than those of us who are willing to fall

because we have learned how to rise

With skinned knees and bruised hearts;

we choose owning our stories of struggle,

over hiding, over hustling, over pretending.

When we we deny our stories, they define us. 

When we run from struggle, we are never free.

So we turn toward truth and look it in the eye.

We will not be characters in our stories.

Not villains, not victims, not even heroes.

We are the authors of our lives.

We write out own daring endings.

We craft love from heartbreak.

compassion from shame,

grace from disappointment,

courage from failure.

Showing up is our power.

Story is our way home. Truth is our song.

We are the brave and brokenhearted.

We are rising strong. 

Thank-you.

[anticipated applause].

Questions and group discussion. 

:-) Thanks for reading it. I hope I get to present it. I even had ideas to modify it for non-profit care providing agencies and public school teachers. Stupid covid and global pandemics. 

Cancelled Conferences and Front Lines

This morning I should be standing in front of a large group of social workers at the Alberta College of Social Workers presenting: Shame Resilience for Social Workers. I was excited and scared to do this and disappointed and relieved when the conference was cancelled in the name of Physical Distancing.

I first gave the talk in April 2017 to the BSW Supervisor's during their end of year appreciation luncheon. Leanne Hilsen, from the Faculty of Social Work at U of C, Edmonton Division asked me to do it and it was an unpaid gig. She introduced me to the work of Vikki Reynold's a kick-ass social worker from Vancouver. Vikki was supposed to be the key note speaker of the conference this morning. There was a 'come full circle' feeling that didn't get to complete itself. There is a weird dissatisfaction from that open end. I hope to complete it.

When I gave the talk in 2017 I was mostly talking to people who didn't directly work with people receiving services- they were supervisors and a handful of professors and we were on Saskatchewan Drive upstairs at the Faculty Club- far away from the proverbial front lines. And social workers were feeling good- we had an NDP government and a handful of our own Registered Social Workers in power! Life was good! And when I talked about our collective professional struggles including the political, I'm not sure if they could relate.

Fast forward to September 2019 when I wrote up the proposal to re-do this talk for a larger social work audience-- the UCP were in power and delaying their budget until after the federal election in October. I started to prepare the talk as the budget of deep cuts were announced, unions and others were organizing and we were all noticing the chasm between those of us who remember the Klein years of the 1990's and those who only knew the stories. The divided world of Alberta politics versus social justice and human rights was flared.

And then COVID. Or Fucking Covid (FC) as I like to call it.

We need the shame resilience more than ever. There are so many "front lines" now. And we are paying attention to them in top priority and missing some of the many other important ones. Right now we are preparing for the physical disease- as we should be-- and health care truly is the front line. And we recognize the front line of 'essential services' as never before: grocery store staff, pharmacies, store cleaners, delivery people and the trucking industry. These are so important! These are all about the physical necessities and staying alive.

There are social and economic implications to this virus that we are only seeing the ice berg tip of right now because we are in early days. We see the 'front line' of services to the most vulnerable people- in Edmonton that's the shelter set-up at the Expo Centre for people without a place to call 'home'. And the social workers and other community workers who are risking their own health to show up for those in need.

And we have the Federal government staff who working to get Canadians financial benefits as soon as possible. They are creating and rolling out a brand new benefit on the fly within only a few weeks.

The front line I see are the kinship care providers, foster parents, child and youth care counselors and case managers who are continuing to provide services to the children who are out of parental care. These vulnerable children are sensitive to the stress of adults, acting out or inward when their environment triggers them. As FC  (remember, that's Fucking Covid) drifts further into our communities, these people continue to care for the children under circumstances much more difficult than normal.

So many homes were set-up to function well WITH community supports- school, respite weekends, rec centre passes, therapy and other professional support, FAMILY visits. These same children with their sensitive stress response systems have lost any bits of life that helped to calm and regulate them. (An entire post could be dedicated to the losses of these vulnerable children and the impact of temporarily losing family visits.)

No one has a contract with Children's Services that says they agree to quarantine with the children in their home or group care facility.

And until recently none of these agencies and homes had a "Pandemic Policy."

And now with FC, these front line caregivers are going ahead and trying to adapt to a new reality. We don't know how it is going in all the homes of all the families who are now inside with their children, but we do hold a higher standard for the foster parents and group care staff to ensure that these vulnerable children are cared for. These are unprecedented circumstances and they are working beyond the role they ever agreed to take on.

And this is where we need shame resilience more than ever. When our nervous system is activated and collapsing though the early days of trying to find our way into this new way of being, we will make mistakes. And when we do, can we be kind to ourselves and know that our best (even when we don't have a lot) is in fact enough? To keep trying is our goal NOT getting it right every time. I will say more about this when I get to writing up the workshop I am not presenting today.

I'll stop here for now. Feel free to write your thoughts from your perspective and experience about the front lines you see, are experiencing or appreciate.

Counseling in the age of physical distance

I feel like the Italians I watched on video last week-- they are in isolation talking to the "me from 10-days ago". And here we are 8 days since large events were cancelled and 5 days since the schools, libraries and rec centres closed. 

I'm not going to lose my job. In fact my job just got busier and more complex for not only the next several weeks as we are isolating, but for the next several years. It's hard for most people to see how far into the future the long-term social implications will reach. So many families rely on separation into different daytime activities; the use of recreation centres, lessons, the public library for managing the fabric of their family life. And my feminist allies know, the brunt of the mental and emotional work will fall to the women. 

And that's where telehealth on-line counseling comes in. You don't need to struggle and suffer alone. We all require someone to help us make sense of our experience and when our go-to friends are also struggling, it can be hard to feel there is space for our issues.

Consider reaching out to arrange a video counseling session. It can help you vent, have your emotional states and thoughts untangled and reflected back for you to decide their meaning and help you to re-group and start again. There are rougher seas ahead (as much as I don't want to admit that) and you don't need to sail alone.

Birth-Shame and Empathy

This post (slightly different version) was originally published as an article in Birthing (Calgary) in October 2013.

Birth-Shame and Empathy

Birth and shame aren’t ideas that usually go together. When we think of shame, we may wince or feel repulsed. We have all experienced shame at some time and thinking of it may cause an uncomfortable visceral reaction. Birth, on the other hand, although often misrepresented and oversimplified as a miracle, a battle survived or both, can immediately bring up a varied and emotional reaction in us. Our culture’s simplistic view of birth does not represent the multi-dimensional experience of most women. Birth fundamentally changes our sense of self. Many women would identify the first birth experience as the marker of changing from maiden to mother. And this transformative process can be as glorious as it is shame-triggering.

Dr. Brene Brown is a shame and vulnerability researcher and author from the University of Houston. She has written three books: I thought it was just me, but it isn’t (2007); The Gifts of Imperfection (2010) and Daring Greatly (2012). Brown has also recorded two TED talks: The Power of Vulnerability (2010) and Listening to Shame (2010). Her work provides a lens through which to understand birth-shame in our culture. Relying on my first birth experience and using the shame-resilience work of Dr. Brene Brown, I am going to offer a view of a different facet of birth, including strategies for how to help a woman through birth-shame.

(I could start a birth-shame meeting.) Hello. My name is Heather and I have shame about my birth. (Cough, sputter, choke!) I have had three children in two births. My first birth started as the ever important: “Midwife-Assisted Home Birth with Birthing Pool” (I’m awesome!) and more than 40 hours later was renamed: “Hospital Transfer with Epidural” (Epic failure?) The result of that process was my beautiful daughter, Isabelle, and the most extreme mixed emotions I have ever experienced:

I felt like I was in-love for the first time!

I was angry and upset about why the birth didn’t go ‘right’.

I felt broken as a woman that I couldn’t have the birth I wanted.

I felt alone and frustrated when people said: “But look what you have- a healthy beautiful baby!”

In the midst of this post-partum emotional storm and an inhumane lack of sleep, I struggled through the early days of breastfeeding. The emotional roller coaster rivaled nothing I had ever experienced and the underlying message of all my thoughts in those early weeks were: “I love this baby more than anything in the world” and “What the #*%@ is wrong with me?”

Understanding Shame
Brown describes shame as “the full-contact emotion” that may include physical symptoms such as knots in the stomach, nausea, shaking, flushing and wincing (Brown, 2007) Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of acceptance and belonging” (Brown, 2007, 30). Shame says: I am not ____________enough. Fill-in the blank: good, worthy, deserving, healthy, informed, rich, skinny and so on (Brown, 2012).

Shame and guilt are very different although both are very uncomfortable feelings. Whereas guilt says: I did something bad, shame says: I am bad.  Guilt can be productive and keep our relationships in check. In guilt, we hold up our behavior against our values and self-evaluate. Guilt is adaptive and helps us to change our behaviour (Brown, 2007). We can grow and change for the better from a place of feeling we have done something that isn’t in line with our beliefs and values.

Shame, on the other hand, is the intensely painful belief that we are flawed- I am bad- and therefore unworthy of love and acceptance (Brown, 2007). It’s a feeling of being broken in a way that can’t be fixed. Shame is highly correlated with addiction, depression, violence and eating disorders. Brown says the three things to know about shame are: 1) it’s universal, we all experience it (except for sociopaths); 2) no one likes to talk about it; and 3) the less we talk about it, the more we experience it (Brown, 2012). Shame is felt the same for both men and women, but it is organized and understood differently by gender. According to Brown’s research, men’s experience of shame is about being perceived as weak or a failure. Men can feel forced to stay in a narrow box of what is considered masculine in our culture. Vulnerability and authentic emotional expression is misunderstood as weakness (Brown, 2012).

For women, shame is understood as a web of competing and conflicting expectations. Shame comes from being perceived as anything less than perfect in multiple and often conflicting areas of our life. For example, a woman can’t be the perfect employee and the perfect mother in the same moment and shame is the feeling she is left with: I’m not good enough. I can’t do it all (Brown, 2012).

The symptoms of shame sound like post-partum sleep deprivation and hormone overload: nausea, stomach ache, shakiness. How can I separate out all the emotional and physical feelings? But, “I’m not good enough as a mom”—that was the feeling I had after Isabelle was born! I didn’t recognize it then, but if I couldn’t even birth her like I intended, how could I be good enough as her mother?

Birth Preparation in a Culture of Scarcity
Brown describes the culture of scarcity as fuelling our ‘never_____ enough’ thinking. The components of a culture of scarcity include fear, comparison, shame and subsequent disengagement to protect ourselves from feeling vulnerable (Brown, 2012). We compare ourselves to others and are compared by others. When we feel we ‘aren’t _____ enough’, we are fearful of rejection and so disengage to protect our self from feeling vulnerable. When we are afraid to be vulnerable because the culture is one of harsh comparison and shame, we don’t take risks. We don’t act real and we don’t offer all we may have to offer. Brown asserts that this struggle with shame and avoiding vulnerability is shaping the culture we live in (Brown, 2012). There is less creativity and innovation and instead people keep up the status quo and try not to be noticed. This is true for our larger society as well as our smaller institutions of work, school, community and family (Brown, 2012).

Consider a girl who is raised in a culture of scarcity. She will develop vulnerability shields to protect herself from feeling fear, shame and disconnection. Perfectionism is one such vulnerability shield (Brown, 2012). Appearing perfect, or close to it, is an adaptive response and for a young woman to demonstrate her worthiness of belonging. Brown also refers to this as the “hustle for worthiness”. Racheal Simons, in her book, The Curse of the Good Girl  states, "Many of the most accomplished girls are disconnecting from the truest parts of themselves, sacrificing essential self-knowledge to the pressure of who they think they ought to be" (p. 28). The culture of scarcity feeds the good-girl/ gold-star thinking. For example, a young girl in school may not feel good enough or worthy of belonging (shame) and so she performs at an extraordinary level (appears perfect) in order to get the accolades (gold stars, approval and acceptance) which allow her to feel worthy. This is the good-girl’s modus operandi for the demonstration of her value and assured acceptance.

Now consider this girl-as-a-woman 6 months pregnant and preparing to give birth.

In this culture of scarcity, when a woman is pregnant and considering birth options, the message of ‘never_______ enough’ will inform her: “You will not be safe enough. You will not know enough. You/ your body are not trustworthy enough.” From this place, a woman may be fearful and disengaged and allow decisions to be made solely by health care providers. A woman may forfeit her right to autonomy over her body and be disconnected from her own self-knowledge. The culture of scarcity questions a woman’s capacity to have her own wisdom or any input. This is illustrated in the Monty Python movie, The Meaning of Life: The woman is on a table about to give birth and asks the doctor, “What do I do?” The response is, “Nothing, dear. You’re not qualified.” The message: you don’t know enough.

What about a woman who is able to move past this never enough thinking? Brown states that when we are able to get out of scarcity thinking and choose to push into new areas, shame runs another tape: Who do you think you are?  This is shame saying: stay small; don’t get too big for your britches. When a woman chooses non-normative circumstances for her birth, her decision may be viewed as subversive and upsetting to those around her. This may be reflected by messages from family and friends. Although their love and concern is genuine, their message is often well-steeped in the scarcity culture of never enough thinking.

When good-girl/ gold-star thinking is applied to an upcoming birth, the self-talk goes something like this: “I am going to research birth and choose the best way to birth. I am going to make sure that this birth is safest or most natural or most medically attended there has ever been. I will be great at this. I’ve read the most highly recommended books. I’ve got the best doctor/ midwife/ doula and I’ve done all the best birthing classes.”

Hmmmm…the culture of scarcity fits. I know these messages. I had been a pretty classic ‘good-girl’ through my younger years. I hate admitting it, but I probably took all that passion to achieve and do it ‘perfectly’ into my pregnancy. When I wasn’t feeling fearful, making comparisons and worried about being good enough, I might have been looking for the way to make my birth the most natural, relaxed, fear-less A+ gold-star birth that I could.

A midwife once told me that a woman in labor is a woman in labor. It doesn’t matter what she does in her daily life- artist, accountant or nurse- it’s all the same in labor. This is very bad news for the woman with good girl/ gold star thinking. The labyrinth path of labor is about letting go and trusting. It’s impossible to be perfect and vulnerable at the same time; to hear the whispers of ‘never enough’ and let go.

In the early post-partum days, I thought: I should have stayed home longer. I should have spoken up more. My body betrayed me. I wasn’t mentally strong enough or physically fit enough. I didn’t let go enough. I didn’t go inside enough. I wasn’t fearless enough.

Elements of Shame Resilience
Dr. Brown’s shame resilience model has four elements: 1) Recognizing shame and understanding triggers; 2) practicing critical awareness; 3) reaching out; and 4) speaking shame (Brown, 2007). It is not a linear process and we move back and forth between elements when sorting out shame (Brown, 2012).

The first element is to recognize shame. That is, to know when we are in it and what it feels like in our bodies (Brown, 2007). When we feel shame, can we recognize it and see what messages triggered it? Brown identifies twelve categories of shame triggers: appearance and body image, motherhood/ fatherhood, family, parenting, money and work, mental and physical health, sex, aging, religion, being stereotyped, speaking out and surviving trauma (Brown, 2007). Pregnancy and birth is a minefield of shame triggers. Body image, sex, mothering are all potential areas of shame triggers. Indeed, any of these categories of shame triggers could come up for a woman during pregnancy and birth.

The second element, practicing critical awareness, refers to stepping back and seeing from a bigger perspective (Brown, 2007. It’s a process of reality-checking. Are the messages that are driving our shame realistic? Did the messages originate in the culture of scarcity and come to us via our family of origin or the media? Related to birthing, especially changing birth plans or increased birth interventions, it’s important to understand the bigger picture of the culture in which we birth. It’s also important to know the facts of each of our specific situations and the multitude of factors that contribute to the birth process.

The third element of shame resilience, reaching out, refers to seeking out someone who has earned the right to hear our story and who will be able to respond with empathy (Brown, 2007). Briefly, empathy is a skill set that involves taking another person’s perspective, staying out of judgement and communicating an understanding of the underlying emotion (Brown, 2007 citing Wiseman 1162). Empathy is the antidote to shame and reaching out means reaching out to someone who can do that for us.

This fourth element, speaking shame, means that we call shame by its name when we recognize it. Shame is not guilt, embarrassment or humiliation. It is not depression, anger or anxiety. Shame relies on being kept secret and it grows in silence (Brown, 2007). However, when we can call shame by its name, it withers (Brown, 2012). The tricky part is you can’t meet another person’s shame head on. It can cause more shame. Instead you can help a person sort out their feelings and when you hear ‘not____ enough’ thoughts and feelings, you can help to name it. Empathy is the key to this process (Brown, 2007).

I had lots of feelings after the birth, but the feeling that I hadn’t birthed well enough and therefore wasn’t good enough as a mom was shame. It would have been helpful for me to be able to name it then. I wouldn’t have wanted someone else to point it out explicitly, but that was the core of my struggle. Critical awareness came after the fact, when I confirmed that Isabelle’s fetal position was associated with long hard labors. It wasn’t just me! I wasn’t the only factor in the messy process of labor and birth. Having a bigger perspective of understanding the culture of scarcity or even reflecting on the birth films I watched during pregnancy, helped me see that there were messages about labor and birth expectations that fueled my post-partum shame.

Empathy
Shame withers when it is named and shrinks to nothing when it is met with empathy (Brown, 2007). The elements, reaching out and speaking shame require another person who is able to provide an empathetic response. Empathy is a skill set and it is often not our first response (Brown, 2007). To understand empathy, consider the following responses^[1]:

Mother/ MIL/ Aunt/Grandma: You shouldn’t have tried to labor at home. It certainly was better that you ended up at the hospital and you were safe. I would hate to think what could have happened.

Friend who just had home water birth with triplets while riding a unicycle: I’m so sorry that you had to have those interventions; you poor thing.

Sister/Cousin/Helpful friend: It was hard, but at least you have a beautiful baby now and that’s the main thing.

The first response is judgement. The second response is sympathy where the person is feeling bad for you, but not with you (Brown, 2007). The third response, Brown refers to as, “at least”  and it discounts and jumps over the feeling of shame. All of these responses are about the other person’s own discomfort with shame. Judgement is super-powered by the culture of scarcity. We make comparisons so that we may feel better about our self. We judge in areas where we feel inadequate. The discomfort of not feeling good enough can be partially discharged through judging another. The thinking is: “I may not feel good enough, but compared to her (right now), I’m great!” The difficulty is that this only further feeds into the culture of scarcity.

Sympathy is different from empathy. Sympathy can actually feed feelings of shame. Sympathy is about standing far away from the pain of the other person and saying: I feel bad that you are way over there. (And I am definitely not over there with you.) Sympathy then leaves the person in shame feeling even more alone and unworthy of love and acceptance (Brown, 2007).

The third response, ‘at least’, is a form of flood lighting where the person shines a bright light on all that is good and pretends there is no shame. This is a very popular post-partum response to mothers. It can also fuel shame because the new mother now has the shame of not being grateful enough and a further feeling of: “What’s wrong with me? I’m supposed to be happy.” None of the above responses are helpful because they don’t acknowledge the underlying emotion.

Here is an empathic response:

I know you really wanted to birth at home and things didn’t go as you expected. That’s hard. It sounds like you are feeling disappointed and defeated.

A conversation can go on from there as a listener asks questions about what the woman feels or what she thinks could have been different. Empathy doesn’t require that you have had the exact same experience (Brown, 2007). The key is to look under the incident that triggered shame and to identify the emotions. As an empathetic listener, you may not have even given birth, but you know what it’s like to feel disappointed or defeated because those are universal feelings. You can convey your understanding of those feelings. You can be very helpful by facilitating the woman’s exploration of her emotions. Emotional logic, especially as it relates to shame, has its own rules. Emotional logic is not logical. Although a woman may need help with critical awareness and gaining perspective, she first needs to feel understood.

Empathy also doesn’t have to be a rehearsed set of words. Empathy might be conveyed in a knowing glance or with a hug (Brown, 2007). Perhaps the only thing a friend can say is: “I know you’re having a hard time. I don’t know what to say, but I want you to know that I’m here for you. We’ll get through this.” Brown says that if you have one or two friends to whom you can reach out, share a shame story and receive a genuine emphatic response you’re fortunate (Brown, 2007). This is the inner sanctum of your emotional world and it isn’t likely that there are many who have earned the right to hear your most vulnerable feelings and who can meet them with empathy.

After Isabelle’s birth I felt terrible, but I was also confused about what I was feeling.  I had two close friends who could listen and help. One male friend offered that in transferring before I was ready, I missed out on the female equivalent of ‘slaying the lion to prove I’m a man’. I totally felt like that! I felt like I dropped out of the marathon before I was ready and I was profoundly disappointed. It was a relief to have that reflected back to me.

My closest female friend understood my convoluted feelings well and easily conveyed that. She agreed that I probably could have stayed home longer, but it was a hard call for all of us. She reminded me of the facts: dehydrated with no more IV bags at home, ROP fetal position, 30 hours of labor before we transferred, political push and pulls of the day. I knew she understood my feelings and further she gave me perspective in reflecting back the ambiguity of the situation. It was a relief to have facts in the middle of my birth-shame storm.

Wrapping up
Feeling unworthy is the crux of shame. It is relayed to us through messages from the culture of scarcity and internalized as self-deprecating thoughts (Brown, 2012). When we become a mother for the first time and stare into those beautiful eyes, every imperfect part of our self is reflected back. In that reflection, it is easy to think we aren’t worthy enough of the great love we feel. However, we need to find a way[2] to feel worthy of this love because this is the way we show our child the same:  I love you, not in spite of your imperfection, but because of it. Your imperfection is what makes you who you are. You are always worthy of my love. You are always worthy of belonging to me.

If we teach our children to believe they are worthy of love and belonging we might change the world. But we can only do this by letting them see that we too, believe that we are worthy of great love and belonging^[3].

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[1] Fortunately I didn’t hear most of these after Isabelle’s birth. These are illustrative.

[2] For more information, see Brown’s book, The Gifts of Imperfection.

[3] See Neff (2003) for more about self-compassion.

Heather Mackay is a provisional clinical social worker in private practice in Edmonton, Alberta. You can read more about her at: www.pointonthepath.com or reach her at Heather.pointonthepath.com
This article originally appeared in Birthing Magazine. 

Works Cited

Brown, Brene. Daring Greatly. New York: Gotham Books, 2012. Print.

---. I thought it was just me, but it isn’t. New York: Gotham Books, 2007. Print.

---. Listening to shame. TED2012. Long Beach, CA. Filmed March 2012.

www.ted.com/talks/brene_brown_lisening_to_shame.

---. The Gifts of Imperfection. Centre City, MN:  Hazelden,  2010. Print.

---. “The power of vulnerability.” TEDxHuston. Huston, TX. Filmed June 2010.

www.ted.com/talks/brene_brown_on_vulnerability.

Neff, Kirstin. “Self-compassion: An alternative conceptualization of healthy attitude

toward oneself.” Self and Identity, 2003: 85-101.

Simmons, Rachel. The Curse of the Good Girl. London: The Penguin Press, 2009. Print.

The Meaning of Life. Dir. Terry Gilliam. Terry Jones. Perf. John Cleese. The Monty Python

Partnership, 1983. Film.

Wiseman, Teresa. “A concept analysis of empathy.” Journal of Advanced Nursing, June 1996:1162-1167. Print.