Introduction

Working with clients who carry a persistent sense of shame often reveals how deeply these experiences are rooted in early relational patterns. Patricia DeYoung’s Understanding and Treating Chronic Shame (2015) offers a thoughtful and clinically grounded account of how this form of shame takes shape and how it can be approached in therapy. Her writing brings together relational theory and neurobiological insight in a way that illuminates what many clients describe only as a quiet, longstanding feeling of being “wrong” or fundamentally unacceptable. The book has been a useful companion in reflecting on how I identify and work with chronic shame in the therapy room.

What Chronic Shame Means in a Relational Context

DeYoung describes chronic shame as a relationally formed experience of the self as unworthy, fragmented, or fundamentally “wrong”—usually originating in repeated misattunements rather than overt acts of shaming. This resonates strongly with my clinical work. Many clients I meet have not necessarily experienced explicit humiliation, yet they carry a sense of themselves as difficult, disappointing, or invisible.

Chronic shame often becomes woven into a client’s identity. It may sit behind depression, dissociation, masking behaviours, relational withdrawal, perfectionism, or the sense of being “too much” or “not enough.” DeYoung’s view that shame is embodied, neurobiological, and rooted in early relational patterns provides a lens that feels both clinically accurate and deeply humane.

How DeYoung’s Model Supports My Work

What I appreciate in DeYoung’s writing is her focus on attunement—not as a technique, but as an embodied, right-brain process. Chronic shame is not resolved through cognitive restructuring. It requires presence, pacing, co-regulation, and careful attention to the relational field between therapist and client.

In my own practice, this means:

• noticing micro-expressions of collapse or withdrawal
• being mindful of how shame appears in the relationship itself
• offering steady, non-intrusive accompaniment
• respecting the client’s existing strategies for self-protection
• allowing new relational possibilities to emerge gradually

These processes align closely with how I work as a humanistic, relational psychotherapist.

Why This Matters for LGBTQ+ Clients and Neurodivergent Clients

My specialisms in LGBTQ+ and ADHD/neurodivergent populations mean I often work with individuals who have experienced chronic shame arising from social marginalisation, invisibility, or repeated relational misunderstandings.

For LGBTQ+ clients, shame is often shaped by a lack of attuned recognition in early life, compounded by systemic and cultural invalidation. DeYoung’s framework helps me approach this without pathologising: the shame is relational, not intrinsic.

For neurodivergent clients, especially those with ADHD, relational misattunement is common. Many have been labelled “too sensitive,” “too impulsive,” or “lazy,” when in fact their needs were simply not understood. Shame may sit beneath years of trying to compensate, camouflage, or over-perform. DeYoung’s emphasis on right-brain, non-verbal experience is particularly valuable here; many neurodivergent clients struggle to articulate emotion directly, but respond powerfully to relational presence and regulation.

Integrating Theory: Attachment, Trauma, and Neurobiology

DeYoung’s writing intersects meaningfully with other theoretical frameworks I draw on:

• Attachment theory: chronic shame reflects internalised expectations that the self will not be met, understood, or held.
• Intersubjectivity (Atwood & Stolorow): shame becomes traumatic when it cannot be shared, mirrored, or made intelligible in relationship.
• Self-psychology (Kohut): shame emerges when essential self-functions—mirroring, idealising, twinship—are repeatedly disrupted.
• Trauma and polyvagal theory: shame resembles autonomic shutdown; it is a physiological state, not simply an emotion.

Reading DeYoung helps me integrate these perspectives into a coherent approach that honours both the psychological and the embodied aspects of shame.

How I Apply These Ideas in the Therapy Room

Working with chronic shame requires a careful, attuned stance. Some ways I use DeYoung’s insights include:

• Naming shame gently when it appears somatically or relationally
• Allowing slowness, rather than pushing insight prematurely
• Working with dissociation not as resistance but as protection
• Supporting clients to develop curiosity about their inner world without feeling defective
• Providing an emotionally regulated presence that can be borrowed when the client’s shame overwhelms their system
• Holding the relational field steady when shame threatens connection

These approaches help create a space in which shame can be safely acknowledged and metabolised.

Conclusion

DeYoung’s book offers a nuanced and compassionate framework for understanding chronic shame as a relationally shaped, neurobiological process. Her writing reinforces the value of attunement, presence, and embodied relational work—elements that are central to my own therapeutic approach.

For therapists working with trauma, LGBTQ+ clients, or neurodivergent clients, Understanding and Treating Chronic Shame is a valuable text that supports deeply respectful and attuned clinical work.

References

DeYoung, P. A. (2015) Understanding and Treating Chronic Shame: A Relational/Neurobiological Approach. New York: Routledge. ISBN 9781138831209.