BACKGROUND

While guilt and shame are often used synonymously, they are actually distinct feelings with distinct ramifications. Guilt arises from our behavior and its effect on others, while shame stems from our sense of who we are. As Dr. Burgo writes, “I once said something hurtful at a dinner party, and on some level, I intended it to be hurtful. Afterward, I felt guilty because I could see that I had hurt my friend. More painfully, I also felt ashamed that I was the sort of person who would behave that way.¹” Failing to identify and address guilt and shame can have far-reaching consequences for ourselves, our family and friends, our colleagues and our patients. In particular, shame can erode our sense of self-worth and subversively affect our interactions with others, often resulting in behaviors such as lashing out, seeking perfection, diverting blame, self-sacrificing to compensate or withdrawing from those around us². As Dr. Brené Brown discusses, silence and secrecy fuel shame³; thus, if we are to cope with this feeling and facilitate our own personal and professional growth, the first, most important step is to identify these feelings, process through them, and develop plans to help us cope with them in the future.

References

1. https://www.psychologytoday.com/blog/shame/201305/the-difference-between-guilt-and-shame
2. beyondintractability.org/essay/guilt-shame
3. http://www.ted.com/talks/brene_brown_listening_to_shame

ASSIGNMENT

1. Review one or more of the resources below prior to the small group session and come prepared to discuss your reactions to and thoughts about them. Be prepared to discuss if they were insightful to either of the scenarios that you discuss below.

2. Reflect on a situation or role in your life in which you have felt or continue to feel guilt or shame. This could be in a wide variety of settings including with patients, colleagues, family members, or friends. Come to the group with notes that:
   1. Describe the situation. Set the stage and be prepared to be specific to help the group fully appreciate the scenario.
   2. Examine what about the situation caused you to feel guilt and what caused you to feel shame.
   3. Analyze how your feelings of guilt and shame affected the particular situation and/or ongoing interactions in this relationship and/or other relationships in your life.
   4. Describe insights you have gained about yourself by reflecting on this situation/role and how you think it will impact your future identification and management of feeling guilty or ashamed.

3. Now, reflect on a patient-care scenario in which you took care of patient who you perceived felt guilt or shame about their medical condition, the way they were treating it, or one of their behaviors.
   1. Describe the situation. Set the stage and be specific. What did you perceive to be the source of your patient’s guilt/shame ?
   2. Reflect on whether you perceived that your interaction with patient exacerbated or alleviated her feelings of shame.
   3. Analyze your own feelings about the scenario. Did you anticipate that your patient would feel guilty/shameful in that situation?
   4. Describe how this reflection and/or the supplemental resources have influenced your thinking about guilt and shame – both for you and your patients. Discuss how it will impact your future interaction with patients.