Why I created Guide for therapists
Here’s where it began: During my postdoctoral training year, a faculty supervisor pulled me aside one February afternoon and told me, essentially, that I didn’t hold on to clients. He wasn’t sure I’d make it in private practice. I remember a burn behind my eyes and then very little else. I was emotionally underwater.
I didn’t recognize what I’d been carrying from that interaction until almost 10 years later, listening — for the second time — to a podcast episode on shame. Something the guest, Steve Finn PhD, said on Therapist Uncensored about shame being the experience of feeling awful about yourself, cut off from the people around you, landed differently that day, and it hit me like a ton of bricks.
I realized that I had been carrying professional shame for my entire career and had simply never called it that.
Since then, I’ve spent years studying shame theory, reflecting on and addressing my own professional shame, synthesizing the research and doing the work with clients when our shame spots collide. I remember late night google searches for any tidbit of advice or insight to help me through a difficult day when my shame was on fire.
Since finding my way, I wanted to create a map for other therapists, since I didn’t have one. I like giving back and I don’t believe we all have to recreate the wheel. My goal with this guide is to share what I’ve learned through my own process, so you feel less alone. I have created a framework for practicing as a shame-informed clinician that I hope gives you a strong starting point.
You don’t have to adjust your theoretical orientation, style of working with clients or invest in the next trending modality or training module. In fact, you are already working to manage your own professional shame, you just might not know it.
I have organized this guide around the questions I hear most often from therapists who self-identify as struggling with professional shame and want to address it. These are the questions we ask ourselves, usually alone, at 11pm after a hard session or the moment the email hits our inbox with the subject “canceling next week.”
Intentionality when it comes to shame makes all the difference. Addressing my own professional shame was a game-changer for me. It deepened my understanding of the mechanics of shame from a deeply personal place and led to insights and skill in helping my clients navigate their stuck shame spots.
For more: Watch Shame Bite #1: Enhancing Your Clinical Lens with a Shame-Informed Approach where I share my personal journey through professional shame and how adopting a shame-informed lens helped me ground into my professional identity with more sturdiness. And here is a downloadable version of my guide here: The Anatomy & Management of Professional Shame – Keren Sofer Psy.D
Table of Contents
What is professional shame and how come I’ve never been introduced to this concept in all my years of training?
Let me get right to it:
Professional shame is the fear that you are not adequate at some aspect of the work you’ve built your career identity around. It runs the gamut from periodic insecurity that dissipates to a view of yourself as globally incompetent when it comes to your role as a therapist.
I didn’t have a name for it for the first decade of my career as a psychologist.
Once I saw it, the evidence was everywhere, and had been for years.
I calculated, almost compulsively, what percentage of consultations turned into ongoing clients. Counting how many people had left therapy with me, as if the number itself were a verdict. Looking up studies about client retention rates and comparing it to my own outcomes. When a client wanted to drop from weekly to biweekly, I froze — and instead of exploring it with them the way I would have with any other clinical material, I just let it happen and quietly spiraled afterward.
None of this showed on the outside; I hid it well. But underneath, I was seriously entertaining leaving the field for a ceramics studio.
Most of us, in fact maybe nearly all of us, struggle with professional shame at some point in our careers, if we are being honest with ourselves. However, the vast majority of clinicians I know and have worked with were never formally introduced to the deep and vast literature on shame nor exposed to a shame-informed approach to professional development or clinical work.
The key operational term here is “formally” because of course we have had supervisors who give a nod to concepts like imposter syndrome, or insecurities, or the normal uncertainties that come with learning new skills, especially those that involve the very soul of who we are.
But gosh it would be helpful to be given a clear cut name for this, one that has a research basis!
I imagine how reassuring and informative it would have been for me to have known about the pioneering work of Helen Block Lewis, a psychologist and psychoanalyst who reviewed hundreds of transcript sessions – including her own! – and found that shame is often bypassed by the therapist and the client, leading to impasses that feel terrible for both or a collusion that all is fine.
Or that there is an evolutionary reason that shame is hardwired in, and can even be helpful.
It is hard to pinpoint exactly why shame theory is overlooked in our training programs. I suspect it has something to do with discomfort, lack of language and an avoidance that is passed down, maybe that common ‘hazing’ mentality that is rampant in the academic world. I also think it’s a fear – that if those with authority and power within the clinical training world acknowledge their own insecurities, mistakes and blind spots, they would lose status and respect.
The irony is that exactly the opposite is true. We feel sturdier, safer and are much more open with supervisors and bosses who let us in to their own genuine experience and process.
📖 Related Article:
For a deeper look into why we instinctively hide from shame and how avoiding it creates clinical impasses, check out The Shame We Can’t Shake: Why We Avoid It and Why We Shouldn’t.
How do I know if professional shame is getting in my way?
If you’re reading this guide because you suspect something about your own insecurity keeps showing up as a blind spot in session — something you can half-see but can’t quite name — you are already doing the first step of increasing your awareness of shame.
What follows are some markers, drawn from my own experience and from years of speaking with other clinicians about theirs. This will help you determine if and how professional shame is impacting you.
After going through this list, please keep reading. An important dimension of shame that we as therapists must take to heart is that even just reflecting on one’s shame can intensify it…so we have to be sure to affirm and ground ourselves.
The Professional Shame Landscape: Internal & External Signals
Clinical & Administrative Over Functioning
- Fixating on Metrics: You track numbers about your caseload, retention rates, or outcomes with an intensity that has nothing to do with their actual clinical usefulness.
- The Over-Preparation Trap: You spend hours creating meticulous session plans, reviewing notes, or reading clinical interventions for a single client, driven by a fear of being “found out” rather than genuine curiosity.
- Over-Extending Boundaries: You find yourself sliding into over-availability—answering texts at midnight, extending sessions consistently, or lowering fees unsustainably—out of a subconscious belief that your standard therapeutic presence isn’t “enough.”
Threat-Based Reactions to Client Autonomy
- Dread Over Curiosity: A client stepping back—reducing frequency, missing a session, or going quiet—triggers something closer to panic or dread than clinical curiosity.
- Personalizing the “Stuck” Client: When a client isn’t making progress, you immediately default to “What am I doing wrong?” instead of evaluating systemic factors, readiness, or the natural rhythm of therapy.
- Fear of Negative Feedback: A minor critique or a client expressing dissatisfaction feels like a devastating indictment of your entire career rather than a useful piece of clinical data.
Isolation & Comparative Despair
- Relentless Comparison: You compare yourself to peers or social media “expert” clinicians relentlessly, and you rarely come out ahead in your own accounting.
- Sanitizing Supervision or Consultation: You selectively share only your “wins” or neat, tidy cases in peer consultation. You intentionally hide the messy, confusing, or ruptured cases out of fear of judgment.
- The Exit Fantasy: You’ve seriously entertained leaving the field—not because you dislike the work, but because you’re wondering if you are cut out for it.
The “Impostor” Mask & Somatic Toll
- The Confidence Mirage: None of this shows on the outside. People would describe you as competent, grounded, or maybe even highly confident.
- Hyper-Vigilance During Sessions: You are overly caught up in your own head during a session (“Did that sound smart?” “Was that the right modality?”), which ironically pulls you away from being fully present with the client.
- The Post-Session Post-Mortem: You chronically “re-play” sessions in your car or at night, obsessing over a single phrasing choice or a perceived misstep.
Time for a Pause: You may have identified with a handful of these signs, or maybe even most of them. I have identified with every single one of these markers at one point or another.
This does not make me a bad therapist. It makes me a human one. These are not signs of incompetence, but of an isolated nervous system trying to protect itself from the vulnerability of the work.
Where does my professional shame come from?
We do not start our careers with professional shame. If there’s any default mode, it’s the sense that we have just completed highly specialized training and are competent and prepared for our next steps.
Instead, most therapists are carrying a professional shame origin story without recognizing it as a story. It usually sounds like a flat statement of fact:
- “I was completely out of my depth in practicum.”
- “My cohort was light years ahead of me.”
- “I was the student who asked too many questions and annoyed the department.”
Sometimes it runs the other direction—being the favorite, the professor’s star student, the “natural”—which carries its own quiet burden: I have to be perfect, I can’t let them see me struggle.
For others, professional shame may have arisen later on. As therapists, we work with suicidal clients and navigate the intersection of highly ambiguous, difficult ethical dilemmas. We risk being grieved or sued, and we are warned about these possibilities from day one of our training. Of course, we also have the client who we just struggle to connect with or the response that befuddles us, leaving us feeling unprepared and confused.
The vast majority of us go into this work because we care deeply and have a capacity for holding complexity…both qualities that make us vulnerable to taking on a lot, and sometimes more than is ours to hold.
📖 Related Article:
If you want to dig deeper – even before your professional shame story took hold – check out my blog post on determining the origins of our shame which explains the ways our shame origin stories are rooted in family myths. You might even be able to draw a throughline from childhood to how your professional shame took shape.
How do I make inroads on my shame story? It seems so ingrained, I don’t even know where to begin.
It is crucial to recognize that these stories aren’t facts. They’re myths, and they’re usually co-created.
Here is an example:
A trainee who is naturally curious or trying to process their own intense countertransference, paired with a supervisor or professor who doesn’t know how to contain that vulnerability without feeling threatened by it, will often produce the same outcome: a story that locates the problem entirely in the student therapist’s “incompetence” or “defensiveness.”
That is a far more bearable institutional story than one about the supervisor’s own clinical uncertainty or the program’s structural deficits—and it is a way that those in power can disavow their own shame and project it onto their subordinates. The student absorbs the myth and carries it forward into independent clinical practice.
Then, as a licensed therapist, every time that same dynamic or evaluative pressure gets activated, shame comes with it. The therapist either backs off a boundary they should be holding, hides their clinical errors from peer consultation, or over-compensates through rigid adherence to theory instead of trusting the relational space.
Deconstructing Your Shame Narrative
What is your professional shame story? Maybe it’s not a discrete event, but a more diffuse sense of not quite measuring up. As you reflect on this, pay attention to a few specific factors:
- Nuance vs. Simplicity: Is your story highly complex, or is it a rigid, black-and-white narrative?
- Shame often dampens nuance, reducing the story to good vs. bad, right vs. wrong with no opportunity for growth.
- The Detail Gap: Does the memory have vibrant color, or do you struggle to remember exactly what happened, who said what, and how it ended?
- Shame creates a vague haze around the details, even if the feelings remain vivid.
- The Isolation Factor: Who in your life, professional or personal, have you actually told this story to?
- We rarely broadcast these stories; we are often deeply discerning about who we share them with, if anyone at all.
- The Default Anchor: Is this the specific story your mind automatically returns to whenever you feel unsure, alone, or inadequate in your current practice?
- With shame, we tend to lift words or images from the core experience and reexperience them even if we are not explicitly linking them to the shame origin story.
Recognizing the pattern is the key: a graduate school or early career origin story gets overgeneralized, and professional shame starts firing in clinical situations that don’t actually call for it.
I can now see that my professional shame did have a starting point, and I have a story built around it. But what do I actually do about that?
While we cannot change the past, we can develop a new understanding and meaning of it.
Let’s slow down before our clinical training kicks in and we want to jump straight to technical fixes. The order of operations matters when it comes to shame: you must affirm and steady your own shame response before you can do anything useful with it.
You took the brave step of thinking about it – something that we would rather avoid or distract from. I want you to notice what happened when you defined your professional shame story.
Did you happen to observe any new details about your professional shame story?
Maybe it went from a vague sense of dread and unworthiness and now has some shape or narrative around it?
Perhaps you recognized that you had in fact shared this with someone, a loved one, a colleague, who was loving and supportive.
Did you feel any emotional shift – for example, numbness moved to sadness, or fear transformed to anger?
Right now, you are doing the work of getting familiar with your professional shame. Any movement at all is a great sign.
Why?
Because shame’s job is to freeze us and keep us hidden even from ourselves. Its evolutionary purpose is to protect us from violating group boundaries or lashing out at our caregivers when they impose a boundary.
But here’s the dilemma: when shame is not processed, not repaired, it remains frozen. Instead of moving from “I am bad” to “I made a mistake” we stay in the bad zone. And, if shame is rarely addressed explicitly in graduate school or clinical practice, then there is a high likelihood that our professional shame stories continue to create a dense fog around our sense of professional worth.
You have come out of hiding from yourself. And, the movement you experience, by simply allowing yourself to acknowledge the shame, is guiding you in the right direction.
Congratulations :) You have officially taken the step of awareness of shame! This is significant because shame is the one emotion that you are unable to reflect on while you are experiencing it. This means you had to shift out of shame to think about your shame story.
The next time you find yourself in a shame-moment related to your professional identity, remember this:
Because shame produces an immediate physiological freeze state, the first step is purely observational. You cannot intellectually out-think shame while your nervous system is in a collapse or defense response. Awareness means catching the markers we mapped out in the landscape map—the sudden mid-session lecture pivot, the late-night metric checking, or the burn behind your eyes—and naming it for what it is: “My professional shame is firing right now.”
What happens after becoming aware of my professional shame?
I get it. Awareness only gets us so far. Sometimes awareness seems counterproductive…because then we begin to see evidence of shame everywhere. That can be a relief, by giving a name and function to what our bodies, minds and hearts are responding to, but it can also be overwhelming.
That is where affirmation comes into play. It is my hope that even the fact that this guide exists feels affirming to you. It means that not only are you not alone in having professional shame, I do too and enough therapists do as well to make it worth my time to write this guide!
Throughout this guide, you may have noticed places where I draw your attention to your own bravery, willingness, and openness to working through your shame. That was intentional and honest. Shame is the most aversive affect in part because of its paradoxical nature: it signals disconnection, sense of unworthiness and the very thing we need to get out of it is exposure, which is the last thing we want to do when we are in it!
So yes, it takes a willingness to feel uncomfortable at best and awful at worst to engage with it.
Another truth is that you are not always in shame. If you were, you would literally not be able to function as a therapist. You have figured out ways to manage shame when it arises. But you want to get to the core of it for a more sustainable professional experience and engage more effectively with your clients’ shame.
Now its time for you to take the reigns and practice affirming yourself.
What can you point to about your professional identity that you feel steady with? Good about? Even, dare I say, proud of?
This is where your expansiveness and self-compassion get to shine.
Notice how you feel just reading these words right now. I know that can also be uncomfortable for some therapists. Humility and self-flagellation can be values and practices that we are taught to embrace as therapists. However, noticing our areas of stregnth is not conceit or hubristic pride. This is a genuine look at what you have offered even just one client, a way you made a connection and showed care.
When is this work complete?
I want to be honest about that rather than tie this up too neatly.
After my second time teaching my foundational course: Deepening Our Connections: Leveraging Shame to Address Impasses and Improve Psychotherapy Outcomes, and I spent much of that following weekend in a shame hangover. A few critical evaluations, and I found myself cycling through nearly the entire Compass of Shame: negative self-talk, a flash of “well, those people just don’t get it,” two hours of sudden urgent file-organizing, and then, finally, withdrawing to my pottery studio.
The irony wasn’t lost on me — teaching clinicians to recognize shame while being sideswiped by my own.
What brought me back was something I already knew but had lost access to under the freeze: outcome is not a measure of my professional worth. And I needed support to get there — I didn’t pendulate my way out of it alone. I reached out to a trusted colleague, was explicit about my need for reassurance, and she met the moment with me. Even someone who teaches this framework can’t always find her own blind spot without another person pointing at it.
Over time, the grip of my own professional shame has eased considerably. I still have it of course! Ask me on any given day, and I’ll be able to tell you a clinical moment, or thought I had that I question my competence or how I handled a tricky moment with a client. I am able to steady myself, zoom out to the big picture and allow myself to stay emotionally engaged.
That’s the actual takeaway, more than any single technique in this guide: this isn’t a skill you master once, and it isn’t a skill you can fully master solo. It’s a cycle of awareness, affirmation, and facing it that you’ll move through again and again.
Progress means we are able to manage it with more ease, self-love, and acceptance while allowing it to teach us more about ourselves and others.
Read on, because I can’t do this alone…
Can I do this work alone?
Partly. But not fully—and it’s worth being honest about where that line is.
Everything we have discussed in this guide up to this point is work you can initiate on your own: naming your defensive strategies, deconstructing your professional origin story, and practicing affirmation. That work is real, and it matters immensely.
But shame’s primary biological function is to hide. It means there are aspects of your own professional shame that you will never be able to see by yourself, no matter how much self-reflection you do, because the “seeing” is exactly what the shame is organized to prevent.
This is where consultation with colleagues becomes an essential tool in dismantling the grip of shame. Not a colleague to casually vent to or swap complaints with, but a colleague who is explicitly invited to notice out loud what you cannot notice about yourself.
What Low-Shame Peer Consultation Sounds Like:
- “Huh, I’m noticing you sound slightly defensive or angry when you talk about this client’s cancellations. What do you think that’s touching?”
- “I noticed you didn’t charge for that extra-long phone call last Tuesday—what was happening for you in that moment?”
- “You mentioned encouraging this client to email you instead of scheduling an in-person session—any idea what you might be backing away from?”
These small, unglamorous, non-judgmental observations land because they come from entirely outside your blind spot.
How can I continue to work on my professional shame?
I like to think of three pillars when it comes to addressing our professional shame as therapists.
Self-Work: Cultivating Self-Compassion and Curiosity
The first pillar is our own self-work: activating enough self-compassion to enable awareness and curiosity. Moving through this guide means you’ve already taken that first step.
While you don’t have to reinvent the wheel, engaging with existing knowledge is a vital part of this layer. My 3 CE self-study course, Deepening Our Connections: Leveraging Shame to Address Impasses and Improve Psychotherapy Outcomes, is another way to increase your awareness of how shame operates in both the self of the therapist and the relational space with clients.
Community: Discerning Collaborative Connections
The second stone is discerning professionals in the field who are similarly curious, open, and collaborative. That might mean seeking out consultation or supervision with a clinician who is shame-informed, or joining a consultation group. I offer both and welcome you to explore my consultation offerings and trainings.
Integration: Embracing Limitations and Trusting Yourself
The third stone is integration. This means maintaining your professional identity—your theoretical orientation, style, and clinical strengths—through a shame-informed lens.
When professional shame is unintegrated, we tend to chase the newest intervention or trick to “improve” or master our insecurity. When we integrate our past missteps and blind spots, we don’t have to reformulate our entire identity. Instead, we accept the limitations of our clinical tools while recognizing how they serve our clients. We also come to appreciate our professional shame, understanding it as a signal that something important is happening—and that we need to stay self-compassionate and engaged.
I hope your work through this guide has left you feeling understood, more hopeful and with some tangible next steps. I invite you to join my subscriber list to get updates on upcoming CEs, clinical insights, and other resources.