Working With Shame in Therapy: What Therapists Can Do
Shame can be easy to miss in therapy because clients do not always say, “I feel ashamed.” It may show up as an apology, a harsh self-attack, sudden silence, minimizing, defensiveness, or a quick change of subject after something vulnerable.
For therapists, the difficult part is often not recognizing that something changed. It is deciding what to do next.
Should you reassure the client? Challenge the belief? Ask where it came from? Address responsibility? Slow the session down?
A useful starting point is to understand the shame before trying to make it go away.
What shame can sound like in therapy
Clients may say:
- “I know this is stupid.”
- “I’m sorry I’m crying.”
- “I’m pathetic.”
- “I should be over this.”
- “I ruin everything.”
- “You’re only saying that because you’re my therapist.”
- “You would think differently if you really knew me.”
These statements are clinically useful because they often contain a judgment about the person, not only a description of what happened.
“I missed a deadline” can become “I am irresponsible.”
“My relationship ended” can become “I am unlovable.”
“I hurt someone” can become “I am a terrible person.”
The shift from what happened to what this proves about me is often where shame becomes visible.
What to do first when shame shows up
Newer therapists often move too quickly when shame appears. They reassure, challenge, explain, or try to make the client feel better.
Instead, slow the moment down.
1. Notice what changed
You do not need to label the feeling immediately. Start with what you observed.
“Something shifted just now.”
“I noticed you got quieter when you said that.”
Silence, looking away, defensiveness, or withdrawal can mean many things. Ask before deciding that it is shame.
2. Find out what the client thinks it means about them
Try:
“What does this make you think about yourself?”
or
“What are you afraid this says about you?”
This usually gives you more useful information than simply asking, “Are you ashamed?”
3. Check responsibility before you reassure
This is one of the most important clinical distinctions in shame work.
Sometimes the client actually did something harmful. Sometimes they are carrying responsibility for something they did not cause and could not control. Sometimes there is a small part that is theirs and a much larger part that is not.
Ask:
- What actually happened?
- Did someone get hurt?
- What was within the client’s control?
- What did the client know at the time?
- Could they reasonably have predicted what happened?
- Is there something that needs repair?
This helps you avoid two opposite mistakes: reassuring away real harm and letting the client take responsibility for something that was never theirs.
Why reassurance may not work
A client says, “I’m a terrible person.”
The instinctive response is often, “No, you’re not.”
But the client may believe you simply do not know enough yet. They may be thinking, “You don’t know the whole story,” or “If you knew what I did, you would agree with me.”
Instead of arguing with the conclusion, find out what makes it feel true.
“Help me understand what happened that makes you see yourself that way.”
Then listen for the difference between:
“I did something harmful.”
and
“Because I did something harmful, I am a horrible person.”
The first may require accountability and repair. The second has turned behavior into a judgment about the whole person.
When the client really did hurt someone
Shame work should not minimize impact.
If the client caused harm, help them become more specific:
- What did they do?
- How did it affect the other person?
- What are they responsible for?
- What can be repaired?
- What needs to change?
- What would reduce the chance of the same behavior happening again?
Self-punishment is not the same as accountability. “I am permanently bad” does not give the client a path forward. “I did something harmful and I need to address it” does.
When shame comes from trauma, stigma, or real judgment
Not every shame belief is simply a thinking error.
A client may have been abused, humiliated, rejected, discriminated against, mocked, punished, or repeatedly told that an identity, disability, need, body, background, or support requirement made them unacceptable.
In those situations, ask where the message came from and what is happening around the client now.
“What messages have you received about this part of yourself?”
“Where do you feel accepted as you are?”
“What would make things easier or more supportive?”
Sometimes the work involves questioning an internalized shame message. Sometimes the environment, relationship, expectations, or level of support also needs to change.
What if the client becomes overwhelmed or shuts down?
Stop trying to go deeper.
Reduce the pressure, ask fewer questions, and give the client a choice about whether to continue.
“Do you want to keep talking about this, slow down, or leave it here for now?”
If the client appears dissociated, severely overwhelmed, or unable to stay oriented, shift away from deeper shame exploration and prioritize present-moment orientation, grounding, and reduced verbal demand.
A simple decision framework for shame in therapy
When you are unsure what to do next, work through these questions:
- What happened?
- What does the client think it says about them?
- What are they actually responsible for?
- What kind of help is needed?
- Can the client keep talking about this right now?
- Does the client need assessment, consultation, or treatment outside your current training?
The intervention might be listening, grief work, trauma treatment, clarification of responsibility, repair, behavior change, practical support, challenging a harsh self-judgment, addressing stigma, or assessing another clinical concern.
Want the full therapist guide?
Working With Shame in Therapy is a 78-page therapist toolkit with clinical scripts, a shame decision map, mini cases, documentation guidance, an example progress note, a three-page client worksheet, modality examples, quick-reference tools, consultation/referral guidance, and a one-page desk card.
It is designed for the moment when you recognize shame but still need help deciding what to say and what to do next.
Frequently asked questions
What is the difference between shame and guilt in therapy?
Shame often turns an event or behavior into a judgment about the whole person. Guilt is more often focused on what the person believes they did. Either feeling can be accurate or inaccurate, so responsibility still needs to be assessed rather than assumed.
Should I tell a client they have nothing to be ashamed of?
Not before you understand what happened and what the client believes they did wrong. Immediate reassurance can miss real harm, misplaced responsibility, trauma, stigma, or the meaning the client has attached to the event.
What if the client says, “You would think differently if you really knew me”?
Find out what they expect you to think or do if you knew the whole story. That expectation often reveals the belief underneath the shame and may also point to earlier experiences of rejection or judgment.
Is shame work only relational therapy?
No. Shame can be approached through multiple therapies. CBT, ACT, compassion-focused, relational, trauma-focused, and parts-oriented approaches may each be useful depending on what is maintaining the problem and what the client needs.
Kristen McClure, MSW, LCSW is a licensed therapist with more than 30 years of clinical experience. TherapistWorksheet.com creates practical clinical tools, scripts, worksheets, and decision support for therapists.