Shame vs. Guilt: Understanding and Overcoming using DBT with Dr. Kiki Fehling

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Episode Description: In this enlightening episode of The Affirming Minds Podcast, Shaina Siber, LCSW is joined by Dr. Kiki Fehling, a licensed clinical psychologist and expert in Dialectical Behavior Therapy (DBT). Together, they dive deep into the topic of shame, its impact on mental health, and how therapists can address it effectively in clinical practice. Dr. Fehling shares valuable insights into how shame differs from guilt, common ways it manifests in clients, and why addressing shame can be transformative in therapy, particularly for marginalized communities such as LGBTQ+ individuals.

Key Topics Discussed:

• Shame vs. Guilt: Dr. Fehling explains the key differences between shame ("I am bad") and guilt ("I did something bad") and how these emotions affect clients differently. She discusses why guilt can sometimes be helpful, while shame often leads to isolation and hiding.
• The Role of DBT in Addressing Shame: Dr. Fehling shares how Dialectical Behavior Therapy (DBT) skills, especially opposite action, can be used to help clients reduce feelings of shame. She walks listeners through how opposite action works, particularly in reducing shame-driven behaviors.
• Shame in Marginalized Communities: LGBTQ+ individuals are often at higher risk for experiencing shame due to societal stigma and discrimination. Dr. Fehling explores how this impacts their mental health and shares strategies to address these issues in therapy.
• Exposure Therapy and Shame: Dr. Fehling discusses how therapists can use exposure therapy techniques to address shame, creating a safe therapeutic environment that encourages clients to gradually face the things they feel ashamed about.
• Self-Compassion as a Tool for Shame: The importance of cultivating self-compassion as an antidote to shame is highlighted, with Dr. Fehling outlining how mindfulness, common humanity, and self-kindness can help clients heal.
• Practical Therapeutic Techniques: Throughout the episode, practical DBT skills like self-validation, self-soothing, and opposite action are discussed as powerful tools to combat shame and help clients build resilience.

Key Takeaways:

• Understanding Emotions as Biological Signals: Emotions, including shame, are biological signals that provide information and urges. Guilt, for example, urges repair, while shame urges hiding and isolation.
• Creating a Shame-Free Therapeutic Space: Building trust and safety in the therapeutic relationship is essential when addressing shame. This often requires therapists to provide a non-judgmental, validating environment and help clients navigate difficult emotions.
• Using DBT Skills for Shame: Opposite action is a cornerstone technique for reducing shame. By acting in ways that counter shame-driven urges, clients can reduce the emotional intensity over time.
• Shame in Social and Cultural Contexts: In some cultures, shame can serve an adaptive function, but in many cases, it becomes problematic and hinders personal growth. Therapists must recognize the nuanced ways shame affects clients, particularly those from marginalized communities.

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