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Why High Achievers Can Struggle in Therapy

And the antidote for therapist and client.

Key points

  • Patients sometimes deflate when talking about a particular issue and feel unable to discuss it.
  • Shame sometimes causes high achieving patients to delegitimize their experience or pain, such as imposter syndrome, anxiety, or trauma.
  • Addressing this sense of shame is key to making progress in therapy.

We’d been going around and around in circles all session. My client’s social anxiety had been strong the previous week and we were working to understand it and discuss coping with it. But something was off. She seemed distracted. She was shrinking into herself. If she could have sunk into the ground, she would have. I was working hard to keep her engaged. It was a phenomenon I’d seen happen before, dozens if not hundreds of times in session.

I work with many high achieving men and women sorting through imposter syndrome, high anxiety, family issues, and childhood trauma. But sometimes, while working through a particularly entrenched issue, the client deflates and feels incapable of working on the issue at hand. The culprit? Shame.

Instead of addressing the underlying issue, the client begins delegitimizing the issue they bring to session. They feel deep in their bones that they are unworthy of the pain they experience. They should, they are sure, have figured this out already.

 Anna Shvets
Source: Pexels: Anna Shvets

Communication issues get buried beneath a layer of “it’s not that hard. I just need to speak up for myself.”

Anxiety gets buried beneath a layer of “but I’m so blessed.”

Trauma sinks beneath a layer of “it wasn’t that bad.”

To actually address issues in therapy, the client must begin to see their issues as legitimately worthy of attention and “severe” enough to warrant attention. To work on communication issues, “It’s not that hard” must become “well actually, this is tough for me.” For anxiety to lessen, a person must shift from judgment about the anxiety to curiosity and acceptance. To work through trauma, a person must come to see their experience as “traumatic enough” to warrant attention.

What can a client do?

If possible, a client sinking into shame should bring it up with their therapist. This is incredibly difficult; shame thrives in secret. But if the client can start to notice what triggers their shame, they can notice it rise up and let their therapist know what's happening. Solving shame alone may feel too difficult, but acknowledging it gives you a chance to work through it as a team. Together with the therapist, the roots of that shame can be unraveled and replaced with worthiness.

What can a therapist do?

It is the therapist’s job to notice the deflation even if the client struggles to articulate its source. The therapist may notice the client seems disengaged or quiet, maybe even physically sinking down in their chair. Shame looks different in different people. It may mean learning that client's shame triggers alongside them so that the therapist can check in. That’s when the real work can begin.

To find a therapist, visit the Psychology Today Therapy Directory.

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