Introduction
This post considers the implications for psychotherapy of a recent paper on the role of guilt and shame in producing suicidal ideation among women. Here, the role of childhood sexual abuse is the primary interest. The notes are made for my personal use, but posted here in case they are of interest to others and for comment. The paper concerned is as follows.
Kealy, D., Spidel, A. & Ogrodniczuk, J. (2017). Self‐conscious emotions and suicidal ideation among women with and without history of childhood sexual abuse.
Guilt, shame and suicidal ideation: context
The paper’s title includes “self-conscious emotions” which include shame, guilt, embarrassment, jealousy, pride and empathy. However, the paper refers to only two of them: guilt and shame. Of course, both have long been linked with suicide and experiences of sexual abuse. By way of example, the paper suggests the following causal trails:
Perception of burdening/disappointing others → Extreme distorted GUILT → Suicidal thoughts
Feeling profoundly devalued or disgusted at self → SHAME → Suicidal thoughts
Moreover, previous research has shown that context affects the degree to which guilt and shame lead to suicidality. The paper cites previous research by way of examples:
| Context: | Link observed: |
| Active duty military outpatients | GUILT and SUICIDAL IDEATION are strongly linked |
| Patients with body dysmorphia | SHAME and SUICIDAL RISK are strongly linked |
| Patients with OCD | SHAME and SUICIDAL RISK are strongly linked |
Research and clinical practice also show that high levels of shame inhibit recovery following childhood sexual trauma. This new research investigates the relevance of women’s experiences of child sexual abuse to the way guilt and shame can translate into suicidal thoughts.
The paper’s authors wanted to know whether a history of childhood sexual trauma is a factor in the relationship between self-conscious emotions [here meaning guilt and shame] and suicidal thoughts. The study group was women.
What does the research paper tell us?
Guilt and shame in suicidal ideation: key findings
The authors did not find that women with a history of child sexual abuse were more prone to distress than those who were not. This was contrary to their expectations. However, as in other studies, they found a direct positive association between guilt and shame and the frequency of suicidal thoughts. They also found that a history of child sexual abuse did alter the relationship between guilt and shame and suicidal thoughts, roughly as follows:
| Women with no history of childhood sexual abuse | Higher levels of GUILT were associated with suicidal thoughts, but lower levels of SHAME |
| Women with a history of childhood sexual abuse | Higher levels of SHAME were associated with suicidal thoughts, but lower levels of GUILT |
Guilt and shame in suicidal ideation: other implicatons
Other headlines from the paper’s discussion section are as follows:
- It is important to understand the nuanced relationship between shame/guilt and suicidal ideation, in which trauma potentially plays a plays a significant part.
- This has important clinical implications. The study suggests the need for carefully assessing each client’s experience of trauma and guilt/shame; and the aftermath of traumatic experiences should be taken into account to optimise the effectiveness of therapeutic interventions.
The paper goes on to reprise topics such as the links found in previous research between shame and child sexual abuse and indications for therapeutic approaches in different instances. This is relevant to the findings of the paper but not prat of the findings.
Comment
As noted in the paper, the exploration of suicidal ideation is central to psychotherapy where it arises. Indeed, a psychotherapist will routinely explore a client’s sense of guilt or shame where this is present. They will be aware that any childhood trauma, disclosed or not, may be a factor in both the origin of these and of suicidal thoughts.
There is already an extensive literature on working with shame and its consequences among clients who have experienced sexual abuse and those who haven’t. Hence it is not obvious (to me) how therapists can translate the paper’s findings into real-life improvements in working with clients. One possibility is that the ‘careful assessment’ recommended includes more systematic screening for such factors early in the relationship, though this might work against the client-led ethos of some therapists.