Doing the Hard Thing Over and Over: Targeting Unjustified Shame with DBT

I have had many opportunities to present and be on a stage, mostly as a singer, and long before that, my brief stint as a theater major in college. Yet, despite all that, presenting in front of others, when I have to teach or present my own writing or thoughts is a torturous process. Despite my long career as a licensed clinical social worker supporting patients and their families in medical settings during very difficult times, I never thought I could teach or lead a group.  

I would observe colleagues or others teach in clinical or other settings and immediately comparison thoughts would arise: 

• “You’re not smart enough”, 

• “everyone will see you don’t really get it and you will be soooo embarrassed”, 

• “you have ADHD, how the heck do you think you can organize how and what to teach and THEN remember it?” 

• “Will group clients think I am incompetent?”  

• “Will they be bored?” 

• “I’ll never be as good a teacher as (name any colleague)”.  

You get the drift.  All my shame and anxiety thoughts kept loading on to me like monstrous clowns coming out of a clown car.  However, I felt a very strong calling to be a DBT therapist and I knew this was part of that job.  I also knew I didn’t want to be held back by fears of failing.

As part of my training to be a DBT skills group leader, I had the wonderful opportunity to co-lead groups with my mentor Charese Allen. In addition to learning about the skills themselves, Charese did a beautiful job modeling for me being kind, wise and non-judgmental as she held the group. And then the day arrived in which she said to me it was time for me to begin leading the group. I pushed back saying I wasn’t ready, but eventually it really was my turn. 

While I was terrified, it meant a lot that Charese believed in me and I knew she would not have asked if she did not believe I was capable. For approximately eight months, I led a skills group while she co-led. 

I have done some very hard things in my career and in many ways this was the hardest. First, I had to deepen my knowledge about each skill and I spent hours each week preparing to teach that week’s lesson. Each week, I felt terror and incredibly anxious leading up to the group start time. During the group, I was aware that my mentor and trainer was observing whether or not I flopped, managed to do okay and/or hit it out of the ballpark.  And every week, after the group, we would review what went well and what I could improve. AND, there was a lot to improve.  

One day, I left feeling ashamed about a mistake I made.  I drove home thinking I needed to quit as I wasn’t cut out for this. Upon arriving home, I completed a pros and cons practice for whether or not to change an emotion, a skill that I would be teaching the following week. What stood out for me from this practice was that shame was just a way to punish myself and even more, it didn’t teach me anything about how to improve. Once I moved past the shame, it was much clearer to me how I could do it better next time. 

My mentor’s philosophy about growth as a clinician was the opposite of catastrophizing.  When I made mistakes or when she gave me feedback about how to improve, she always started with asking me what I thought went well and what I could have done better. It mattered that she gave honest feedback and suggestions kindly, while also encouraging me to think critically yet compassionately about how to improve. 

Early in my DBT career, I heard a story Katherine Korslund told when during her own training,  Linda Dimeff asked her, “Do you want to be told you are good? Or do you want to be good?” Both are prominent figures in the DBT world and have dedicated their careers to researching and development of DBT.  This quote was inspirational for me and helped me to approach and actively seek out feedback as part of my growth process. 

Interestingly, I am not alone in fearing public speaking. According to the National Social Anxiety Center, up to 40% of people experience fear of public speaking. For many of us, the urge to avoid the discomfort of anxiety is enough to avoid opportunities that might be tied to a life or career goal. 

Here is a list of skills I used to help me approach rather than avoid learning to be a DBT skills group leader: 

• Opposite Action to Shame (all the way)  I held a confident body posture even if I didn’t feel that way. Standing proud and head held high, encouragement statements and remembering my successes. Before each group, Charese and I would laugh as we imitated body builders flexing their muscles.

• Mindfulness of Current Thoughts  I remembered to treat my thoughts as thoughts through observing and labeling them. 

• How and What mindfulness skills

Participation and one mindfully  I practiced being fully present in the moment. When my mind drifted or I panicked, I practiced returning back to the present. 

Non-judgmentally  I worked hard to maintain a growth mindset. When I observed shame or self-judgments, I did my best to practice self-compassion. I found Pema Chӧdrӧn’s book, Fail, Fail Again, Fail Better an especially helpful resource to get me back on track. 

Observe and Describe  If I was particularly anxious, the hour before I needed to leave to teach, I took a mindful walk around my neighborhood and focused on observing and describing the flora of my neighborhood - colors, details of what I observed and smells.  If it was warm, I focused on the warmth of the sun and how the light impacted the colors all around me.

• Paced Breathing A distress tolerance skill that brings our parasympathetic nervous system back on line by exhaling for longer than inhaling. This was something I could easily do during the drive to my office.

• Coping Ahead I created a list of the specific skills I knew would be helpful. To help my brain remember my plan, I used imaginal rehearsal so my plan was accessible when I needed it. I imagined things going well, which helped me to calm and feel more confident. 

• Building Mastery The more and more that I taught, I began to feel more capable and confident, even in areas of my life outside of my work.

• Loving kindness practices and self-encouragement Even if I did not believe the encouragement statements, they blocked the catastrophizing and self-critical thoughts from entering my mind.

Over time, I began to notice I felt more at ease, that I knew the skills well enough to teach them through my study and my own use of the skills, and my ability to not just focus on what I was teaching, but really be able to hold the group in the way my mentor had shown me.  I was also able to forgive myself when I didn’t show up the way I wanted. 

From a clinical perspective, what I engaged in was informal exposure. I did the hard thing over and over and over again. In my pursuit to actually “be good”, I learned to bypass the shame to leave room for growth. I also taught my brain I was much more capable then I thought, that teaching and leading a group wasn’t as dangerous as I had anticipated, and that making a mistake was not evidence of my overall capabilities. I also have learned to elicit feedback from clients and colleagues to improve my skills as clinician and skills group leader.  

After teaching skills groups for over six years, do I still experience anxiety, fear and have comparison thoughts? Well, yes. The difference is that the thoughts take up a lot less space in my brain and I can feel a sense of freedom by not letting them tell me who I am and what I am capable of.  

A final note on shame and anxiety. While shame is an unjustified emotion that is not particularly helpful in the situation I am describing, anxiety about public speaking doesn’t have to be our enemy. The famed actor Laurence Olivier once said that the day he stopped feeling nervous would be the day he would have to stop acting. When we are able to use skills to get to and stay within our window of tolerance, anxiety can give us the message that something is important to us and provide us with the adrenaline needed to increase our focus. And, as much as we may wish it, we can’t turn an emotion on and off like a light switch. What would happen if, after we use skills to return to our window of tolerance, we were to turn to the anxiety to say thank you for helping me, I’ve got this.