​By Sheila Rubin, LMFT, RDT/BCT

(Adapted from my chapter "Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet" in the book Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients by Stephanie L. Brooke, editor.)



PART ONE

I begin this article about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Porta Pak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before this book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype or Zoom if I have met the client at least once in person. I have come a long way.

 

Therapy on the Phone or Internet

Therapy, on both phone and internet, is with individuals or couples. When I am not physically with a client, I find that I check more often for feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session. For example: Make a list of the coping skills from the session and put them on your calendar day by day. Or: Take the powerful objects from this session and put them out in your room at home with a note by each to remind you what we did in the session today. If the session helped them find a vision to support the marriage, we have that symbol, like a strong tree holding both of them as they deal with difficulties during the week.

 

Concerns about Technology

What about when technology fails? When a person just revealed something they’ve been hiding and the screen suddenly freezes? A while ago, I was in the middle of a Skype session where a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted with my frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone, and by the time I reached them, the tender moment had passed and they were fighting again. I had to slow things down and gently find the words to tell them about the negative cycle their communication was in and how to do a repair to get out of it.

 

As Kaufman says, shame is the rupture of the interpersonal bridge (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame. And this couple was experiencing a disruption in connection. I was eventually able to use the symbol of disconnection because of the unpredictability of the internet as a way for each of them to have a role of explorer rather than blaming each other.

 

What I realized was I have to let clients know ahead of time about the constraints and the benefits of using the phone or internet for therapy. It will save them time coming to my office when they are in a difficult place, but it may not be as contained as an in-person session.

 

One couple was struggling with the husband having had an online affair and the wife needing to check his phone in order to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get agreement before we began to talk:

Because we are not face to face, I can’t just interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying, so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, and each of us is on a cell phone, if one of us gets disconnected for any reason we need to have a plan. Are each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected.  Call me back on your phone and I will use my phone to accept both calls.

 

 

Shame During the Session

In my chapter in The Self in Performance, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.”

 

When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the screen, I don’t know what they are experiencing and truly expressing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride, when we are seen in a good light, and shame, when we make a mistake or are seen in a less than favorable light. Diana Fosha (1992) later wrote that we call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember when a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.

 

Listen for Subtle Signs of Shame

In the chapter “Treating Family Systems with Shame and Addiction Problems,” Ron Potter-Efron wrote that:

Clients do not always directly communicate their experience of shame with their counselors. Rather, they may hint at their shame through relatively subtle cues, downcast eyes, sudden speech stoppages, avoidance of an apparently innocuous topic, unusual phrases, and so forth. They may also speak at length about other emotions regarding a particular experience without adding that they also or even primarily feel shame about it (p. 230).

He suggests the importance of the interactive process between the therapist and client can even be more important than the client actually disclosing the feelings of shame because the client expects that the therapist will dismiss them. He explains, “Shamed clients have a specific hope, not necessarily stated, within the counseling relationship. They desire to reveal everything within them that feels dirty, disgusting, and defective. They seldom reveal all this material immediately and may never be able to share some of it” (p. 229). He explained how the therapist needs to gently layer by layer work carefully and not reject the client as they reveal more levels of shame during the sessions.

 

Internet Therapy

The good news is that the internet can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of having the direct eye contact family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting and reported being filled with rage because her son didn’t call her as often after his baby came, and because the other grandparent was being invited over and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents, and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her frustration. I invited her to role play the visit with the grandchild. She rocked back and forth. Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invitations to visit increased.

 

Containment

Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. There are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.

 

Case Example of Phone Session

This client was feeling dark. Her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

Client: “He’s still in the role of letting his ex-wife rely on him. I couldn’t stop crying for hours. My emotions got all wacky or something. I see his side when he’s helping his kids. But every act of his kindness is an act of affection toward his ex-wife. One day it’s good between us, and the next day I feel ignored, neglected.”

Therapist: “How about if you choose something in your room to represent your feeling neglected and ignored.”

Client: “OK, this plant.”

Therapist: “Can you move it near you and look closer at it? And as you are looking at it, what does it say to you? What does it symbolize?”

Client: “You have to pay attention to a flower. You have to water it or it dies!”

Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be very powerful metaphor. Having it in front of her helped her to focus on it during the whole session.

Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels because he’s with his ex-lover. Why am I punishing myself? I could go out and be in another relationship!”

Therapist: “So there’s another part of you that doesn’t want to be punished any more, that wants to find another relationship, one where the guy is choosing you instead of choosing his ex. Can you look around the room and find an object that represents this part of you?”

This is another place I want to pause the session and give her time to feel the power of what she just said. I want a symbol for that part so we can talk to that part as well, maybe have a conversation with both of them.

Client: “This candle!”

Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

Client: (Surprised) “There’s a light in it! I can attract things… People! But I’m not ready to move on.”

Therapist: “Can you give each a voice? What does the flower say and what does the candle say to you?”

The candle told her that she is bright inside when she’s not so depressed, worrying what is going on with this guy she’s dating. It gives her inspiration to grow herself and step out of the relationship to a real relationship where someone could really be available for her. As she was expressing this, another feeling showed up.

Client: “I feel deep anxiety.”

Therapist: “Where is the anxiety in your body?”

Client: “My diaphragm.”

Therapist: “Can you put some space around it and take some slow deep breaths?”

Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He says kind things to me, offers to work it out. I really care about him. He’s clear about his intention that he wants to be with me!”

Therapist: “There are a lot of conflicting feelings.”

Because we are on the phone, I want to keep the connection and let her know that I am here and that I hear her.

Client: “I’m scared. Lonely.”

Therapist: “Yes, there’s a part that’s scared and lonely.”

I want to support this part.

Client: “It’s like a pouting child!”

And it feels like she is putting down that part. It is like some part of her is shaming that part of her for wanting what she is wanting.

Therapist: “I wonder… I’m curious if there is some shame around that part?”

Client: “Yes.”

Therapist: “Can you look around and find an object to represent the part that comes out and shames you when you talk about your attachment needs?”

Client: (Apparently looking around her room for a few moments) “A hat.”

Therapist: “How does a hat represent shame?”

Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

Client: “Yes. If I’d recognize those things, logically, I would leave.”

Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him, and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

Client: “He told me he couldn’t have me over because he didn’t want his neighbors to think I was a homewrecker because his ex just moved out. So now I feel shame for wanting to come to his house. It’s been over six months we’ve been dating. So when is he going to tell people?”

Therapist: “How did you feel when he said that?

Client: “Insecure! Nerves all over my body. On edge!”

Therapist: “What did the nerves say?”

Client: “Run!”

Therapist: “And what did you do when you felt that strong urge to run?”

Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

Client: “Yes. That was terrible. But I want to give this guy more opportunity, more time to show me that he can make the life for us he is always promising. I want to give him the benefit of my doubts. I want this relationship to work.”

Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

Client: “The plant says, ‘You’re making yourself suffer!’”

Therapist: “What does the hat say?”

Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

Therapist: “What does the candle say?”

Client: “It says that I don’t need to shame myself for my feelings. I have light inside me. I need to remember.”

I’m wanting her to stop here and reflect and to work to understand if maybe there is something here for her to be shameful for. That would be a form of healthy shame.

Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she is doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things in a different way. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, ‘What did I get from this session?’ Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions.”

• What does the plant say?
• What does the candle say?
• What does the hat say about how you shame yourself?
• Listen to the shame and feel if there is something of value here or if it is just putting you down.
• Is there part of it that is valid?
• Is there something to listen to that is actually shaming for a reason in this situation?
• Is there something here from a past relationship or a situation where you felt shamed?
• Is there something you feel shy about?
• Is there something for you to learn about shame here?

 

In Dancing with Fire, A Mindful Way of Loving Relationships (2013) John Amadeo writes “Stumbling into adolescence and adulthood we may continue to hear the message that we are too selfish, needy, or flawed to be loved. The resulting isolation generates emotional suffering that is often unbearable. This begins an epic journey of scrambling to figure out who we need to be in order to win love and connection” (p.23). He writes that we lose the thread of connection with ourselves. “Shame prompts us to seek affirmation and approval rather than connection and intimacy. We look outside ourselves to sense whether we’re emotionally safe” (p 111). Many people end up looking outside themselves to find out how they feel or even what they should be doing.

See part 2 for the continuation of this article.

​PART TWO

Understanding Shame

Shame is a primary emotion. The role of shame is to warn us and protect us. Our nervous system shuts down and we actually lose cognitive ability when we are feeling ashamed. Two indicators of shame are confusion and stuckness. Shame can freeze both mind and body. Shame is so difficult to see and cope with because it often hides behind other emotions. Shame is wired into our nervous system to protect us by lowering our emotional intensity and capacity to act. It is important to differentiate healthy shame, which can help us pause and rethink, from toxic shame, which can produce paralysis and leave a person so frozen that he or she is incapable of action and clear thinking. Healthy shame can lead a person to take responsibility for his or her actions, reassess, and make changes.
 
Daniel Hughes, in Attachment Focused Family Therapy, writes that shame places a person in a fog that gets in the way of the intersubjective experience of being understood with empathy that can help a person gain understanding and acceptance. Also, shame itself can prevent a person from being able to reflect on their behavior or experience (p. 184). In the Eight Keys to Safe Trauma Recovery (2000), Babette Rothschild notes that “shame, quite simply, tells us that something is amiss” (p. 87) and that “Rather than discharge, as an example in yelling or crying, shame dissipates, when it is understood or acknowledged by a supportive other. More than any other feeling, I find that shame needs contact to diminish” (p. 92). Rothschild describes a process for deciding when to address shame, understanding the value of shame, apportioning shame fairly, and sharing shame (pp. 98–100).
 
Shyness

In the book The Authentic Heart, John Amadeo explains shyness can actually be a friend. “Shyness is an entrance into a tender fold within your authentic heart” (p. 110). But shame can cut both ways. “shame can be debilitating when you’re ashamed of your shame” (p.70). By replacing control with trust and by beginning to trust and express feelings, shyness can serve as a guide to use shame in a healthy way. One of my clients reported the comfort of shame like a blanket, like a burka, covering her grief after the sudden loss of her father and the shame of friends who expected her to just return to work after her three days of mourning period. Many clients let this feeling of extreme shyness, even social anxiety get in their way of making friends or living their life.
 
Role Development

In the chapter “Psychodrama” by Antonia Garcia and Dale Richard Buchanan in Current Approaches in Drama Therapy by David Read Johnson and Renée Emunah, editors (p. 396): “Moreno believed that the self emerges from the roles we play. He postulated that when people learn a new role, they follow a particular pattern of role development. The arc of the learning curve begins with role taking and proceeds to role playing and role creating.” The authors also say: “Dysfunction occurs when a person has a lack of either social roles or psychodramatic roles, and function is seen as having a balance of both.”
First, a person can’t imagine a certain role, so I tell them a story about someone who had that experience. Then I may suggest a conversation that that person may have. Moreno wrote that “In order to develop functionally, each of us must first be doubled as newborns” (p. 43). So much of the work I do in the therapy session is about mirroring the client.
 
This list is from my chapter “Almost Magic: Working with the Shame that Underlies Depression” in The Use of the Creative Therapies in Treating Depression, edited by Charles Meyers and Stephanie Brooke. I wrote a series of therapeutic processes to work with shame that can be used over the internet as well, as I describe in the case that follows (p. 236).
 
Working with Shame

• Counter-shaming: Help the client experience a series of successes. Focus on strengths.
• Grounding
• Contribute some personal sharing to join with the client and show humanity, join them in imperfection.
• Provide psycho-education about shame.
• Mindfulness or observing ego
• Use objects or symbols to externalize shame and process current shame.
• Separate shame from other emotions. Objects or scarves or pillows can be used as symbols.
• Use projective or embodied processes to explore where the shame may have originally come from.
• Introduce a protector.
• Find aesthetic distance for the client to work with the shame.
• Use projective or expressive processes to work with the shame.
• Find the person’s true voice.
• Give back the shame to where it came from.
• Witness the powerful healing taking place.
• Embody the new role, the new voice. Try a posture or movement.

 
A teenaged client complained of feeling “a presence watching me sometimes.” As we worked, I wanted to understand about the presence she sometimes felt while undressing and also when she got home from school. I wondered if it was perhaps an externalized voice of her inner critic, so I asked general questions about how she felt at school, at home, and listened for something that said she might feel judged or criticized. I asked when she felt the presence most strongly. She said she felt it most strongly in school when, even though she knew the answer, she felt shy to raise her hand, worrying that the other person would be thinking that she would give the wrong answer and that maybe wasn’t smart. She had fears of letting herself down and letting down her family. Over time I normalized her concerns by telling her that some of the developmental jobs of this particular time in her life were about comparison and finding her way socially as well as academically. I shared briefly about my shyness in high school and ways that I overcame it. This helped to normalize what she was going through and model that it was possible to get through it.
 
I helped her begin to feel inside her body by doing grounding exercises and stomping her feet. At some point she could feel inside her body and began to feel lighter and more hopeful. The next time she felt the presence was on a trip, and she was able to use coping skills to put her attention on other things. During one Skype session we used symbolic imagery to represent the part of her that was afraid that if she showed up as her real self in school, and people still didn’t like her, then she would feel destroyed.  Describing the imagery helped her to develop empathy for the part of her that needed protection.
 
In one session I asked her to imagine a movie or play with similar characters to the situation the client is coping with in her life, like a waitress and a customer. I said, “Let’s say the waitress made a mistake with the order. And in the first scene, let’s say the customer is a mom who used to work as a waitress. How would the girl who was a waitress feel? Terrible, just terrible. And if the customer left a big tip then the waitress would realize that she had gone through the whole dinner remembering her mistake and thinking about it.” I asked, “Would you have compassion for the young waitress? You know how hard a job that is and she is just learning.” My client replied, “Yes, but you know, if the woman gave her a big tip it is because she probably thought she was a loser.”
 
“Wow,” I said, “That’s pretty critical. Let’s change the scene. Same kind of scene, but a different movie. Let’s say it’s the same waitress and the customer is someone her same age. Let’s say he’s a guy this time, a cute guy. So how would the waitress feel if she made a mistake at his table?” “Even worse,” she said. “So much worse, because he’s someone she wants to impress. That would be horrible!!! She probably would just feel like she’s wrong for even thinking he was cute, if she made a mistake with his order.” “And what about the tip? What if he left a big tip?” “That would be the worst,” she said. “Why?” I asked. She sighed and said, “If it was someone her own age and she made a mistake, that would be horrible.” “Why?” I asked. “Because he would know how awful she really was.”
 
As we discussed the imaginary scenes and went into detail exploring the different levels of imagining embarrassment, my listening to her rather than judging her allowed her to share the level of inner criticism she was coping with.
 
“So is there something you could tell the waitress about each of those scenes?” I asked. “Given that it’s a new job with a high learning process, what would you tell the waitress, if you could, to reassure her?” I asked her to replay the scene one more time, then said, “If you could go back and change one thing after the mistake, what would it be?”
 
For the first scene my client had the waitress tell the female customer how sorry she was, and that she was just learning this new waitress job. I asked her to imagine how the woman would respond. She said, “She might laugh in a kind way and say that she remembers what it’s like to learn something new.”
 
I asked her how that felt. She paused and said, “Not so bad when we talk about it.” I had her go back into the second scene with the cute guy. She imagined telling him later that it was her first day, so of course the job was new. She imagined the waitress then joking with the guy and both of them laughing! I asked, “How does that feel?” “So much better,” she said. I asked, “So how does your body feel?” She replied, “Lighter… A little more space.” “Where is the space?” I asked. She pointed to her chest. We both breathe a sigh of relief together over Skype.
 
As we unpacked the scene, she admitted surprise at how easy it was to imagine the waitress talking about her mistake and saying what was happening for her instead of keeping it all inside! I asked about the feelings of embarrassment. She said they were much less. And she couldn’t wait to practice this next week. I ask what she’s taking from the session, and she reports feeling lighter and less worried about the pressure she has been feeling.
 
I explained that we were working on several levels. One level was giving her tools to cope with the experience of the presence and the shyness. On another level we were working with symbols to understand the role that the presence had for her and other ways to relate to it. On another level we were working developmentally about what it is to be female in high school and all the issues of dating, finding her place with the other kids socially and intellectually. She began to understand that the presence was something she could gain more control over, by shifting her focus away from it by talking to family, friends, and getting busy with schoolwork. Eventually she realized she had gained a different relationship to it and it bothered her less and less. As she became more comfortable with saying what was going on with her instead of hiding behind her shyness, friends started to reach out to her more and she didn’t feel as alone.
 
The power of somatic imagery helped. Role plays that we did over Skype helped. The eye contact we had over Skype helped her feel normal and that this was part of her life journey. She reported learning to laugh at herself, something that had been very hard, in a way that was counter-shaming for herself and the other person. She reported that it took the pressure off of herself and the other person when in an uncomfortable moment. She said that sometimes she wasn’t worried what the other person was thinking.
 
Along the way we found things she could say in her new role of power, taking her locus of control back: “I’m committed, I’m ready, I’m in control. In sessions she felt a calmness in her body and a relaxedness. That’s how I would track. I would track her aliveness returning in the sessions. She first felt like a cold fish. After each session she felt a little more hopeful and a little surer of herself. Her somatic awareness also increased. She became more hopeful and began taking a few risks by sharing more what was going on with her. We found a way for her to talk to herself in a kind counter-shaming voice inside.
 
Imagination Activated via Drama Therapy and Expressive Arts Therapy

From our workshops and from an unpublished paper on “Healing Shame in the Imaginal Realm,” Bret Lyon, Ph.D. and I present that:

When a person gets stuck in shame, the most powerful way to get unstuck may be to activate his or her imagination. In the imaginal realm, logic and time are fluid and flexible. What actually happened can be explored and changed. What was stuck can be reexamined and shifted. Shaming situations from the past can be revisited, excavated through writing and expressive exercises, and thereby shifted. There are ways to give back the shame to where it belongs—through drawing, writing, and imagining past shaming experiences and saying now what you wish you had said then. Structured writing and expressive processes can symbolically give back the shame. This is where to find resilience.
 
This work needs to be done with extra care when the session is over the internet, because the person can quietly slip into the shame vortex. I develop exercises to help them have something to hold on to during and after the session.
 
Renée Emunah, in her book Acting For Real (1992), writes about “Drama Therapy as the intentional and systematic use of drama and theater processes to achieve psychological growth and change.” Psychodramatist and child psychiatrist Adam Blatner, expounded in “Foundations for Psychodrama” that psychodrama can offer a place for expressing unexpressed feelings and even replaying scenes of the past, expressing feelings now that have not been expressed, and for opening new possibilities for the future.” There is the idea of surplus reality in which a person can play with and change a conversation or an event that happened in the past where they felt shame and replay it to take a new role. The idea of act hunger that can be explored where unexpressed parts of a person can be invited into the psychodrama scene. Sometimes I use psychodrama just sitting with a client and ask them to imagine some things.
 
 
Conclusion: Working with Counter-Shaming Metaphors

There is much to be explored in this new world of online therapy. There is much to be explored. There is much to be created. I am excited about being able to reach people who don’t live near me and to do work online. I am excited about developing ways to work through shyness and awkwardness and shame using a combination of drama therapy, expressive arts and attachment work/psychotherapy. What I realize is that because they are home or at work when we do the session, they can actually have a power symbol or drawing or object on the shelf that we work with during the session and put on their desk or shelf behind them to help them keep ahold of the changes between sessions.
 
References

Amadeo, J. (2001). The Authentic Heart: An Eightfold Path to Midlife Love. New York, John Wiley and Sons.

Amadeo.  J. (2013). Dancing with Fire, A Mindful Way to Loving Relationships. Weaten, Il, Quest Books.

Blatner, A. (1988). Foundations of Psychodrama: History, Theory, and Practice. New York, NY: Springer Publishing.

Emunah, R. (1994). Acting for Real: Drama Therapy Process, Technique, and Performance. New York, NY: Brunner/Mazel.

Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. New York, NY: Basic Books.

Graham, Linda.  (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being.  Novato, Ca.: New World Library.

Lyon, B. and Rubin, S “Through the Looking Glass, Using Imaginal Resources to Heal Shame; A Workshop for Therapists,” an unpublished paper, Berkeley, CA

Hughes, D. A. (2007). Attachment-Focused Family Therapy. New York, NY: Norton & Company.

Potter-Efron, R. (2011) “Therapy with Shame Prone Alcoholic and Drug Dependent Clients.” In Shame in the Therapy Hour by Dearing and Tangney, APP

Johnson, S. (2005). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds, NY, NY. The Guilford Press.

Kaufman, G. (1974). “On Shame, Identity and the Dynamic of Change.” Paper presented at the annual meeting of the American Psychological Association, New Orleans, LA. Retrieved from http://files.eric.ed.gov/fulltext/ED097605.pdf

Kaufman, G. (1992). Shame: The Power of Caring (3rd ed.). Rochester, NY: Schenkman Books.

Nathanson, D. L. (1992). Shame and Pride: Affect, Sex, and the Birth of the Self. New York, NY: W. W. Norton & Company.

Rubin, S. ((2015) “Almost Magic, Working with the Shame That Underlies Depression; Using Drama Therapy in the Imaginal

Realm,” in The Use of the Creative Therapies in Treating Depression, eds. Brooke S. and Meyers, Springfield Illinois, C. Charles Thomas.

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