May I present  Sarah… She was a middle-aged woman who came to me to resolve her panic attacks. Although we did not name it until her third or fourth session, we began working with her shame immediately while we brought her anxiety to manageable levels by balancing her nervous system. Because Sarah’s anxiety caused her shame, and at the root of her anxiety was a shameful experience, there was no getting around the shame work, but pouncing on her shame directly would have sent her out of her skin.

Sarah began our first session antsy. She sat on the couch, then the chair, then the fitness call. Of course her body wanted to move, she was riddled with anxiety. I began by asking her if she would like to sit on the floor. She did and a few minutes later, she craned her neck to my wall of inspiring quotes where I have about a dozen quotes floating on a white background. Then, she turned back to re-engage with me. Feel free to get up and have a look if you want, I said. There was a very quick flash of curiosity and joy on her face.

Sarah’s shame and anxiety stemmed from her early childhood. Her older sister would drag Sarah to bed in an attempt to protect herself from being molested by their older brother. As you would imagine, this strategy didn’t work. The brother saw three year old Sarah as no threat.  Sarah, at that age, knew a bad, shameful act was taking place by her sister’s reaction. Unable to distinguish the complexities of the situation, she took on the disowned shame of her perpetrator brother and the helplessness of her sister while developing her own anxiety, unable to escape the situation.

After three sessions, I saw the re-occurring enactment of Sarah lying down in my office and her anxiety spiking, her body startling. She confided to me that she was embarrassed about her reaction. I shared with her my story of how embarrassed I was having a panic attack on a plane many years before.

I asked Sarah if I can hold her ankles and be with that part of her that could tell she was not alone. She agreed. Her feet started twitching under my hands. As she worked through the anxiety her head and shoulders curled down and remained there as if stuck. I gently invited her to notice her navel. We did navel work in both previous sessions so she can locate it and hold a presence there along with her fear. I asked her to notice what was different when these spikes came up this time. She told me: I could feel you there in a nice way, feeling my navel helped me to breath, and I felt scared but a little less than usual and I didn’t feel bad about myself.

There were a handful of sessions after that, but the work really began to flow after this session. Her panic attacks, which were crippling her, became very infrequent and her self esteem increased to the point that she decided to leave her boyfriend because she felt he was triggering her anxiety and she believed she deserved better.

AST Principles in Action

  • Not naming shame immediately to avoid causing more shame
  • The neuro-binder aspect of shame. How it was bound up with her early childhood experience and her current adult state.
  • I chose to water her seeds of authentic impulse. I did not try to prepare her to have a session. Her movement signaled the work had begun. Her body had a story to tell.
  • I truly respected her exploratory process and recognized this as an important developmental need that did not get met, in conjunction with natural curiosity.
  • I recognized what lay beneath the shame/anxiety jumble: thwarted impulse, unmet need, self-expression, release of pent up energy/fear, etc.
  • I distinguished the projected shame and helplessness in her body from her impulse to run and receive help and protection.
  • I normalized the shame and created connection while the shame attack was occurring.
  • Together we broke the social isolation that surrounded her shame and her childhood wounding.  She was able to feel shifts in her body, and she was able to distinguish herself from her shame reaction.

What did you notice taking place in this case study? I look forward to your thoughts, concerns, questions. Please post these on the new AST blog.