Ronda L. Dearing

Shame in the therapy hour

Excessive shame can be associated with poor psychological adjustment, interpersonal difficulties, and overall poor life functioning. Consequently, shame is prevalent among individuals undergoing psychotherapy. Yet, there is limited guidance for clinicians trying to help their clients deal with shame-related concerns. This book explores the manifestations of shame and presents several approaches for treatment. It brings together the insights of master clinicians from different theoretical and practice orientations, such as psychodynamics, object relations, emotion-focused therapy, functional analysis, group therapy, family therapy, and couples therapy. The chapters address all aspects of shame, including how it develops, how it relates to psychological difficulties, how to recognize it, and how to help clients resolve it. Strategies for dealing with therapist shame are also provided, since therapist shame can be triggered during sessions and can complicate the therapeutic alliance. With rich, detailed case studies in almost every chapter, this book will be a practical resource for clinicians working with a broad range of populations and clinical problems.

Exploring Shame, Guilt, and Risky Substance Use Among Sexual Minority Men and Women

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.

Women's Social Behavior When Meeting New Men: The Influence of Alcohol and Childhood Sexual Abuse

Heavy alcohol consumption (Testa & Parks, 1996) and childhood sexual abuse (CSA; Messman-Moore & Long, 2003) have been associated with adult sexual victimization. We examined the social behavior of 42 women under two alcohol conditions (high dose and low dose) in a bar laboratory. Women were videotaped interacting with a man they had just met. Women in the higher dose condition engaged in more open body position and talked, stood, and walked more than women in the lower dose condition. These behaviors are consistent with signs of intoxication or romantic interest. The women in the high-dose condition also frowned more than women in the low-dose condition. An increase in frowning could indicate less comfort or may be considered consistent with an increase in animation during the social interaction given the concomitant increase in other behaviors. Thus, the nonverbal behavior of women in the high-dose condition could be interpreted as mixed signals. CSA victims exhibited fewer head movements (e.g., nods), were less animated, and frowned more than non-CSA victims. These behaviors convey reticence or possibly even anxiety or discomfort during the social interaction. Thus, the nonverbal behavior of women with a history of CSA may convey an unease that could be viewed by a potential perpetrator as vulnerability. Our findings suggest that both acute alcohol consumption and history of CSA may influence nonverbal social behavior and may influence risk for sexual assault by sending mixed cues of romantic interest or signs of vulnerability to potential perpetrators.

The Moral Emotions, Alcohol Dependence, and HIV Risk Behavior in an Incarcerated Sample

This article examines the relationship of shame, guilt, and symptoms of alcohol dependence to pre-incarceration HIV risk behaviors in an ongoing study in a metropolitan jail. Between 2002 and 2004 an ethnically diverse sample of 368 male inmates (mean age = 31, SD = 9.7), were interviewed on a variety of constructs including shame- and guilt-proneness (), alcohol dependence (), and HIV risk behavior (). Symptoms of alcohol dependence were associated with elevated levels of HIV risk behavior (risky needle use and unprotected sex) prior to incarceration. Guilt-proneness was negatively related to risky sexual behavior. In addition, there was an interaction between shame and symptoms of alcohol dependence. Specifically, among those who were low on alcohol dependence, shame-proneness was negatively related to risky sexual behavior. The studys limitations are noted and findings are discussed in the context of the importance of considering moral emotions and alcohol dependence when designing programs to reduce HIV risk.

Tobacco Smoking Among Male and Female Alcohol Treatment-seekers: Clinical Complexities, Treatment Length of Stay, and Goal Achievement

Background: Literature suggests that tobacco smoking among clients in alcohol treatment has important clinical implications, including poorer treatment outcome. Much of this literature, however, has been derived from research-based treatment samples that utilized stringent inclusion and exclusion criteria, limiting generalizability of findings. Objective: In order to further our understanding of the correlates of smoking among clients with alcohol problems, the present research examines tobacco smoking status at admission for 21,128 adult treatment seekers from 253 community outpatient substance abuse clinics across New York State. Methods: This sample includes tobacco smokers at admission (62%) and women (25%). Clinical complexities at admission (unemployment, lack of high school diploma/GED, criminal justice involvement, mental illness, polysubstance abuse) and length of treatment stay and alcohol-related goal achievement at discharge were assessed by clinic staff. Results: Mixed models revealed that tobacco smoking was significantly associated with all five clinical complexities; interactions with gender indicated that this association was stronger for women with regard to criminal justice involvement and polysubstance abuse. Also, these smokers evidenced shorter substance disorder treatment duration and were less likely to achieve alcohol-related treatment goals relative to their nonsmoking counterparts. Conclusions: Admission tobacco smoking status of alcohol treatment seekers is an important client characteristic with regard to clinical presentation and treatment outcome. Our findings underscore the need to further our understanding of the complexities associated with smoking and especially as it pertains to female smokers.

Characteristics of alcoholic smokers, nonsmokers, and former smokers: personality, negative affect, alcohol involvement, and treatment participation.

INTRODUCTION Previous research has indicated that smoking behavior in the general population is linked to personality traits such as behavioral undercontrol and negative emotionality, but it is unknown whether these traits pertain to alcoholic smokers. Further, prior research has not established whether alcoholic smokers differ from their nonsmoking counterparts in terms of alcohol involvement severity and treatment participation. Exploration of these associations is important, given the high prevalence of cigarette smoking among alcoholics. METHODS Treatment-seeking alcoholics were categorized into daily cigarette smokers (n = 76), nonsmokers (n = 34), and former smokers (n = 33). These groups were compared on personality traits, negative affect, alcohol involvement, and alcohol outpatient treatment participation. RESULTS All three groups scored similarly on a variety of personality traits (e.g., extraversion and neuroticism), and on most aspects of negative affect, with the exception of anxiety (smokers scored higher than nonsmokers and former smokers). In terms of alcohol involvement, alcoholic smokers reported greater negative drinking consequences and alcohol physical dependence relative to former smokers, even considering that alcoholic smokers had relatively more abstinent days. Finally, alcoholic smokers attended considerably fewer alcohol outpatient treatment sessions relative to both nonsmokers and former smokers. CONCLUSIONS Common risk factors for both alcoholism and smoking behavior, such as personality traits and negative affect, may obscure personality differences between smokers and nonsmokers in an alcohol treatment sample. Furthermore, findings suggest that current nicotine use among alcoholics is associated with greater anxiety and severity of alcoholism than among their former-smoking counterparts.

Does change in self-perceived problem drinker identity relate to change in alcohol use? An examination of nontreatment seeking hazardous drinkers.

Identity change is related to reductions in alcohol use among treatment seekers, but it is unclear the extent to which identity change is associated with reductions in alcohol use among nontreatment seeking hazardous drinkers. The goal of the current study was to examine whether change in problem drinker identity (i.e., self-reported identification as a problem or nonproblem drinker) was associated with reductions in heavy drinking among nontreatment seeking hazardous drinkers. Participants (n = 149) completed measures to assess alcohol use and were asked if they identified as a problem drinker at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Two groups were compared: (a) those who identified as a problem drinker at baseline but identified as a nonproblem drinker at 12 months and (b) those who did not make the same transition. Latent mixture modeling was conducted to examine whether change in problem drinker identity was predictive of heavy drinking latent class growth trajectories. The results indicated that a self-reported transition from identification as a problem drinker to identification as a nonproblem drinker was associated with greater reductions in heavy drinking over the assessment period and a 7 times greater likelihood of being in a rapidly decreasing heavy drinking latent trajectory class compared with participants who did not make the same transition. Self-reported transitions in identity appear to be a good predictor of heavy drinking trajectories among nontreatment seekers. A better understanding of what predicts transitions in drinking identity among non-treatment and treatment seekers is needed.

Super Bowl Sunday: Risky Business for At-Risk (Male) Drinkers?

Background: Major sporting events and other festive occasions are typically associated with alcohol consumption; however, little is known about risky drinking during events such as the “Super Bowl.” Objectives: We sought to determine whether drinking on Super Bowl Sunday differed from Saturdays (the heaviest drinking day of the week) surrounding the date of the Super Bowl among at-risk drinkers. Methods: Heavy drinking participants (N = 208) were recruited via advertisements for a 2-year prospective study of drinking behaviors. From this larger sample, 196 were selected for whom the date of the Super Bowl was included in their daily alcohol consumption reports (including reports of abstinence on those days) for 2006, 2007, and/or 2008. Participants’ average age was 36.4 (SD = 12.9); 49.5% were women. Participants at the point of recruitment were not seeking treatment and had not been in alcohol treatment in the past year. Results: Analyses using multilevel modeling comparing Super Bowl Sunday to Saturdays indicated that men drank more alcohol on Super Bowl Sunday across all 3 years, whereas womens drinking was higher in only one of the 3 years. Conclusions/Importance: These findings suggest that heavy drinking during the Super Bowl (and in association with other sporting events), particularly among men, warrants additional attention due to the potential for deleterious public health consequences.

An ordinary day.

Review Last week: Start by checking on how group members did with acting on last week’s sermon. How did they do witnessing to others about their worry and their trust in God? (Click here for the Discussion Guide to “Reverse Your Worry”) This week: Ask eGroup members to share their favorite points from the sermon, what spoke to them, a phrase or moment from the sermon they related to the most, or questions they have. If members have a hard time recalling the sermon, talk through your notes and share your favorite points. Remind your group that this message was about treating each day as “one day” by believing expectantly to see God move in our lives and sacrificing toward what we’re believing for.