PHILIP M HELFAER

Never mind, she’ll live by and for herself. But she will keep her self-respect. Then that will have been her attainment in life, keeping her self-respect. – Every Man Dies Alone, by Hans Fallada

Description of Self-Respect
In the somatic-energetic point of view, the self is the body, so the idea of self-respect refers, literally, to respect for one’s own body, the body’s spontaneous forms of regulation and expression, and the feelings and states one experiences bodily. Exploring this seemingly simple notion yields multiple levels of meaning and complexity. I believe it remains an unnoticed concept within psychology and that it has significant implications for understanding development and change in therapy. I will develop what I see as some of the essential meanings and implications of this concept.
I believe most people share an understanding of the meaning and quality of an attitude of respect. Respect puts a limit on how the other is to be treated and generally it prohibits abusive behavior toward the respected person or object. Respect is not necessarily love, nor is a loved object always respected, although it should be. Mutual love, however, cannot be sustained in the absence of respect. While most people will understand respect in relation to others or outside objects, I encounter many people in whom an attitude of respect towards their own self is undeveloped, or worse yet, its place is taken over by any of a variety of negative attitudes.
In my experience, attitudes toward the self are very commonly characterized by shame, humiliation, guilt, and by actively self-hating attitudes. In these all too common states, the attitude towards the self is inherently disrespectful. In all these states, there are some aspects of the self, always specifically including the body in whole or part, which are considered to deserve disrespect, punishment, devaluation, or, minimally, disapprobation. Not uncommonly, the rejected part of the self is felt to deserve the worst kind of condemnation or ostracism. Sadly enough, these conditions in various forms are common in almost all cultures and sometimes are even understood as desirable outcomes of development and child rearing.
A major goal and function of all schools of psychotherapy is the alleviation of the impact of these conditions. When, for example, shame is lifted, the individual may experience euphoria (Morrison 1989, p.182). Health, however, can be conceptualized as more than the absence of pathology or disease, just as happiness is not simply the absence of unhappiness, or pleasure the absence of pain. Self-respect is the healthy converse of shame and related conditions. I believe, when it is present, it is characterized by a transparency, a quietness, often not consciously being experienced as such, but functions as an underlying basis of all feeling. However, when the self is confronted with obstacles of various kinds, self-respect may make itself known. Its absence, that is an undeveloped self-respect may, of course, also make itself known. One way “silent” self-respect may show itself is in how the individual cares for him or herself in terms of very basic aspect of self-care such as eating, dress, exercise, sleep, and cleanliness. Sometimes self-disregard is painfully shown in these matters. Perhaps the epidemic of obesity in the developed world reflects this.
My interest in self-respect emerged from my own therapeutic experience (Helfaer, 1998; 2008). I described it this way:

During this difficult period, in a session with Al (my therapist, Alexander Lowen, M.D.), I made the unexpected discovery of the experience of self-respect. I no longer remember the context of the session. I remember suddenly becoming quiet, just standing in the room with Al, who was sitting in the chair beside me. Probably I had been on the bioenergetic stool, maybe crying. I was aware of Al’s supportive and unobtrusive presence. Then I got it. I was me, just myself. All the terrible judgments fell away, all the shameful self-attributions fell away, and for a moment they all disappeared. Here I was, “just” in my body, with all my sorrows, faults, and pain, but I had myself with – and, in my mind, there is only one word for it – self-respect. (Helfaer, 2008).

To this day I see this as the most desirable way of experiencing myself and indeed of being. I would like to use the word, ‘state’, for such an experience. It is not a thought, specifically, although thoughts may arise from it. Neither is it a feeling, nor an attitude, exactly, although feelings and attitudes may also arise from it. A process of this sort, sometimes experienced, sometimes not, reflects a more overall condition or organization. It arises from the state of the organism and the state of the person. Of course, this pleasant state contrasts with other states which are not so pleasant nor so coherent, and I will say more about some of these contrasting states a bit later.
Returning to my experience, the state of self-respect at that moment was a quiet, peaceful way of being in the present moment and being in contact with myself and my surroundings. From such a place, given the motivation, one may choose to move, react, engage, and act, or not. Evaluation of the self is not a part of this experience. It has more to do with a recognition or acknowledgement of being, feelings, states, and other bodily aspects. In this state, one is indeed oriented towards one’s own body-self, yet it is not a way of being that leads to egocentrism or lack of consideration of the other. On the contrary, from this condition, one is in the best possible condition for the recognition of another. At the moment I described, this way of being emerged from me, from my own self, not from the mind or self of my therapist. It did, of course, emerge in the course of my ongoing work with my therapist, although he had not ever spoken to me or referred to this kind of state as such.
Let’s ask what allowed this state to emerge at this moment. As I understand it, there were a number of conditions which allowed it. Overall was the fact that I was finding the work with Al useful and helpful; and, in addition, I enjoyed working with him, felt liked and appreciated by him – we had a nice relationship over the years. However, there are more specific conditions allowing for the emergence of this state. First, I had been able to connect deeply within myself with very painful feelings, and had been able to cry using the breathing exercises. Fortunately, my therapist was able to allow and tolerate my pain and grief; not all therapists can do this. Second, then, there was a deep discharge of tension as a result of the crying. Tension release of this nature allows chronic autonomic arousal to calm down; I felt quieter and calmer, and a huge relief. This kind of tension release also diminishes the charge potential related to the limbic memories associated with the grief and pain.
Here, I can point out that I am describing an energetic process. The energetic process involves a sequence something like the following.

There is a chronic tension in the body. This is experienced as tension in the chest and as a painful depressive feeling. Lying on the bed or the bioenergetic stool and breathing, increases the energy and aliveness of the pain and releases some of the tension. This allows a more specific feeling to emerge, and the feeling emerges and is expressed in crying, an expression of the grief associated with early experience and painful memory, and of the sadness about what happened in my life. The crying releases more tension, and the emotional state, once chronically held in tension, has the opportunity to move through a cycle of completion. Chronic tension and arousal are lowered, and the individual experiences relief and relative calm, perhaps deep calm. Charge potential associated with any limbic or procedural memories associated with the feelings is decreased; and the important implication of this is that the painful feeling is less likely to be triggered or will not be experienced as intensely or overwhelmingly when it is.

There is more to say about what might have allowed or enabled the state of self-respect to emerge. Alexander Lowen is known as the man who developed bioenergetic analysis and founded the International Institute for Bioenergetic Analysis. In his therapeutic work, as well as in his writing, he always kept the focus on the body and the energetic processes of the body. This was the central way he held the therapeutic work. While always attending to the person, he always had a good sense of the somatic-energetic processes within the person. These relate to the chronic (characterological) tensions and arousals, and as a unified whole, underlie personhood in its various aspects, (defensive or healthy). I am saying that his characteristic attitude in his work with me as a patient was based on a respect for the living body and for me as a person as a living body.
I believe this attitude with which Lowen approached his work influenced my own way of experiencing myself even if I was not consciously thinking in such terms at the moment. I can say that this attitude wove into the intersubjective context and also set up a somatic resonance for my experience. My experience of self-respect deepened into a sense of person-organismic state, a state which is a positive developmental force. Such experiences also provide a somatic-energetic basis for the therapist’s own learning and knowing about the somatic-energetic processes in others.
Learning about self-respect can occur at any point in life, and it can be introduced into a therapy from the very beginning. It is not difficult to get the idea. For it to become a functioning ongoing aspect of how the individual relates to him or herself may require help, time, and repeatedly practicing and experiencing it. Experiences of self-respect will usually emerge spontaneously in a good ongoing therapy at some point, but the therapist needs to recognize them as such.
Self-respect can be contrasted with the concept of self-esteem, a psychological concept that is a perennial preoccupation of psychologists and therapists. Educational psychology was involved in ideas and research around self-esteem for a number of years. The idea was that children would be better able to learn, if they did not suffer a loss of self-esteem through any sense of “failure” in the course of their educational experience. The research and efforts in this direction had mixed results for a variety of reasons. Similarly, ordinary narcissism, in psychoanalytic theory has been related to the vicissitudes of the regulation of self-esteem.
Self-esteem is a psychological concept. Self-respect is a body or body-oriented concept. Self-esteem can go “up” and it can go “down.” It involves some kind of self-evaluation, a comparison of the self with an ideal, either internal or external, and is therefore intimately related to shame. Self-respect does not depend on a comparison of the self with a standard. It depends upon contact with the self, that is with the body and the feelings in the body, and it is a consciousness of a state of being.
It is important to note that the state of self-respect does not depend on having a good feeling emotionally or in terms of self-esteem. An elevated self-esteem, for example, might lead to an increase in anxiety for various reasons. In this case, the sense of self-respect has to do with acknowledging and respecting the anxiety for what it is. In addition, self-respect, or the capacity for self-respect, is not negated or eliminated when the person experiences an emotionally painful state. A feeling of rejection or loss may be very painful, and at the same time, that experience can be held in respect. When it is, the painful experience will be felt, integrated, and allowed to complete itself in a manner that allows for the individual to be free to move on without excessive suffering or crippling effects.
Guilt, shame, and humiliation are important affect laden conditions to consider in the light of self-respect. In a sense they are the mirror image of self-respect. Where self-respect implies respect for self and for one’s way of experiencing life, these states inherently sponsor a great variety of qualities and varying degrees of disrespect towards one’s own self and body. In addition, these states, in one or another constellation, play a central role in virtually every human struggle as seen by the psychotherapist.
A somatic-energetic approach is very suitable for these states (Helfaer, 2007), because they are a complex of belief (cognitive structures) and affect and body sensation (somatic-energetic processes). To be effective, a therapeutic approach needs to address the affect, and to do this it is useful to address the actual bodily sensations and states that in essence are functional expressions of these states. For example, the affect of humiliation, might be described as a crushing feeling accompanied by a sickish feeling in the gut and a tendency for the back to fold over.
It is of great help in working with humiliation, shame, or guilt, to help the individual isolate, in his/her awareness the body sensations as much as possible from the beliefs and even the affects which convey “meanings.” With focused work, over time, this is possible, and it allows the individual to begin to bear the state better, and to better access specific feelings, (such as anger, sorrow, outrage, and so on), to begin to identify characteristic ways of defending the self against the humiliation and compensating for it, and then to begin to identify trauma memory sources that generate the chronic humiliation. Each of these stages can be seen as sorting out specific somatic-energetic reactions and processes within the individual on a somatic and feeling level.
As each step in this process is addressed, the therapist can support and encourage the patient to hold the bodily sensations and states with respect. The individual then can develop the capacity for self-respect through the process of encountering painful experience.
In summary, the qualities of an experience or state of self-respect consist of three elements.
 There is a focused awareness of a body state or feeling; when there is an awareness of a feeling, there is also an awareness of the body sensations that are a part of that feeling.
 The awareness is non-evaluative.
 There is an attitude of respect for the state of the body and the self, regardless of whether the body sensation is pleasurable or painful.

A Developmental Line
Self-respect reflects both a function of the self and a state of the self. Self-respect is thus an aspect of the overall development of the self. At the same time, self-respect has a specific developmental line through the years of childhood and adolescence. It is a complex function emerging from the ongoing integration of the great number of experiences based in encounters with the child’s mother and other caretakers. In this regard, it is precisely similar to the development of other complex functions or capacities of selfhood. Self-respect will develop normally in a maturational environment which facilitates it. I can only speculate on whether this kind of positive development is a rare event or a relatively common one, although I am inclined to believe it is not so common.
Elsewhere (Helfaer, 1998/2007, pp. 163-180) I have described in some detail a model for an early childhood facilitating environment for self-respect. This was not a description of developmental stages. It is an analysis specifically of qualities pertaining to the attitude or manner in which the mother and other caretakers relate to, care for, and respond to children. I arbitrarily divided childhood into three periods, and described for each period five dimensions of parenting behavior. Parenting behaviors may be understood in relationship to the child as pertaining to contact, holding, support, nurture, and sexual response. Each interaction reflecting any of these dimensions can be appropriately described as respectful or disrespectful. I assume that respectful means are the necessary conditions for the development of a self-respecting person.
Understanding parental care in terms of five dimensions reveals the richness of the facilitating milieu, how much contact and stimulation is involved continuously between parent and child. It should be noted also that most of the contact with the child involves direct bodily contact or attention directed to the bodily person or movement of the child. The facilitating milieu of early childhood is body to body, hands on, and directly bodily related. It is not made up of symbolic or cognitive functions. Whenever a parent literally touches a child, that touch can convey respect or disrespect. A rough or mechanical handling is not respectful; a caring touch and handling is. I will discuss further the somatic-energetic aspects of the facilitating milieu below.
I mentioned ‘sexual response’ as one of the five dimensions of the facilitating milieu. This calls for explanation. Where does parental sexual response – mother’s, father’s, caretaker’s – come in to the picture of a maturational environment of children? I believe that parents’ respond to the gender of their children from the day they are born. In days before ultrasound could reveal gender, I suspect it was universal that the first words spoken when a child was born were, “It’s a boy,” or “It’s a girl.” This is naming, and it is a sexual response in the sense that it is a direct response to the gender of the child. From the beginning, this recognition may be respectful or quite disrespectful. A newborn can to this day be totally rejected because of being female.
Overall, respectful milieu recognizes the gender and developing sexuality of a child from the beginning, and most parents can be observed to enjoy the boy in the boy and the girl in the girl of their children. Enjoyment of these qualities is a respectful response. For the older child, several qualities characterize the respectful milieu in terms of parental sexual response: acceptance of genitality; allowing the child freedom to love, supporting developments that are express of the child’s gender however they emerge, maintenance of generational boundary, and open heartedness to children’s’ love on the part of parents. All these qualities of the facilitating environment are pertinent to the child’s developing sexuality.
Vignettes from the Field
I will describe and discuss two naturalistic “field observations” to illustrate what I mean by respectful and disrespectful responses and their implications for development. Both of these observations were “collected” by my wife, Velma Helfaer. Seeing the aliveness, naturalness, beauty, and sexuality of young children gives both of us great enjoyment, and when we are out we take an interest in observing how parents respond especially to these qualities in their children. Of course, sometimes we like what we see, and occasionally we find what we see painful, even shocking.

1. A respectful response to a young child.
Velma observed this episode in a large supermarket. A little girl had let out a scream that was so loud that everyone in the store was startled. It was a scream mostly of rage, nothing physically harmful had happened to the child. Velma never did learn what had set her off. She described the sound as having the whole force of the child’s little body behind it. Soon after the scream, Velma saw the little girl with her mother and older sister outside of the store. The child was maybe four years old, prettily dressed in a pink dress and pink shoes, and her hair was nicely done. She was still screaming full force, her whole body vibrating with it. The mother was calmly kneeling down by the child, calmly staying with the child, not trying to control her or even quiet her, and the child kept going until she was done. The mother let her go on as long as she needed. Later, Vellie saw the little girl in the store skipping along as happily as could be. She had completely recovered from her upsetness and showed no ill effects or lingering bad feelings. The older sister had stayed nearby quietly through the episode, although she looked somewhat embarrassed.

Parental soothing, I believe, plays a profoundly important role in children’s development. It might be said to be a form of nurturance as important to toddlers and slightly older children as giving the breast is to the newborn baby. Children can become terribly upset, as everyone knows, and once started into an upset state sometimes are not able to calm themselves down, until they reach a state of exhaustion. Good enough soothing nurturance can result in the internalization of a “holding soothing introject,” the absence of which may contribute to the development of borderline personality disorder (Adler ). This internalization, on the other hand, contributes greatly to the development of the child’s ability to regulate and manage his/her own affect states. Thus, parental response to upsetness can be respectful and it can be disrespectful.
In vignette (1), the mother’s response is admirably respectful. She stays with her child, maintains contact with her without trying to control her, gives her the time she needs, and even manages to create a somewhat private space for her outside of the store. The soothing for this little girl could not have been nicer. The outcome of this episode for the child was evident later when Velma saw the child again happily joining in the family chore of the moment, gathering their food.
The possibilities for disrespectful response in this episode are extensive, and such forms of disrespect are all too commonly observed. The mother might have scolded the child, perhaps roughly, perhaps grabbing her arm and “shushing” her. Easily, she could have given the child a scolding disapproving look, maybe an extremely angry look if she, the mother, felt embarrassed in public by the child. The mother even might have slapped the child, forcing her to quiet down by frightening her. These types of response have severe somatic-energetic consequences.
2. A Disrespectful Response to a Child.
In this scene, a very young girl, maybe one and a half or two years old is in a stroller. Mother was talking on her cell phone, while an older girl walked along beside the stroller. The child in the stroller had twisted herself right around in her seat. She was reaching with her little arms up towards her mother, and she was screaming painfully for her. This was a very different sounding scream from the one described in vignette (1). This scream was so anguished that hearing it made her, that is Velma’s own, heart hurt. The mother continued talking on her cell phone, did not so much as look at the screaming child, or show any other response to the child. The little girl continued to scream with heart-felt pain.
This heart wrenching scene displays a painfully disrespectful response to a very young child. The child is not contacted, soothed, or even responded to. She is left alone with her anguish. This is the kind of response that leaves within the being of the child the deep sense that her needs and yearnings for contact must be unacceptable in and of themselves, that indeed she herself, in her very being is unacceptable, and that, in essence, she is alone in an alien world of others, she herself may not even be of the same species, and is somehow thrown outside the others’ groupings. If the child of vignette (1) had an experience which supported the establishment of self-respect, the child in vignette (2) had an experience which is the foundation for vulnerability to shame, humiliation, and self-hate.
Somatic-Energetic Aspects in Shame Vulnerability and Self-Respect
Shame, as I explained earlier, can be seen as a negative mirror image of self-respect. It would make sense, then, that there is a developmental line for shame that parallels in mirror fashion the developmental line for self-respect. This can be seen in some degree in the above vignettes. Where the conditions for the development of self-respect occur, shame vulnerability does not develop; where there is strong experience building the scaffold for shame vulnerability, self-respect is not in the picture.
The development of shame has been meticulously described both naturalistically and theoretically by Andrew P. Morrison in a series of papers and books (Morrison 1987,1989,1994, 1998/1996). Morrison writes from the perspective of a psychoanalytic self-psychology, and his descriptions of the development of shame do indeed parallel the line of development for self-respect I have thus far described. What is of particular interest to me is that a concept central to Morrison’s description and theory is in fact a somatic-energetic concept; I am referring to the mirroring selfobject. I can illustrate further the somatic-energetic aspects of the development of self-respect by briefly delineating this concept.
Morrison adapts the concept of the mirroring selfobject from the writings of H. Kohut (e.g., Morrison, 1994). The mirroring selfobject, in the language I used earlier, is intrinsic to the facilitating environment, not only for the development of self-respect, but for the development of the self as a whole. The concept of the mirroring selfobject refers not to the mother, or other caretaker, but a function provided by the mother (or other caretaker). The most important function that the mother provides in the early development of the self is positive responsiveness to the aliveness of the child.
If the mother of the little girl in vignette (2) above, had reached down to meet the reaching arms of her child and picked her up, that would have been a mirroring response. The mother would have met the alive needs of her daughter. She would have been empathically attuned. The mother’s behavior we saw is considered an empathic failure, or a misattunement. It has the obvious effect of throwing the child into a chaotic, uncontained state of distress which she cannot manage on her own. She is overwhelmed by stressful affects which means that the condition is traumatic for her.
Attuned mirroring on the mother’s part – soothing, holding, and containing (as in vignette [1]) – allows resolution of intense affects without lingering negative effects. The child returns to the physiology of happy play and engagement. The kind of distress experienced by the child in vignette (2) does not resolve by itself into normal, healthy ongoing being. Calming down, when it finally occurs, will be more the result of exhaustion and energetic collapse than soothing. At this point, the child is left in the physiology of defeat, depletion of energy, and unresolved tension. This will show itself later in a sad, downturned, unhappy, withdrawn, and anxious look. For children, a state like this is “interpreted” as the feeling and subsequent belief that “there must be something wrong with me.” This belief and the state accompanying it will show itself, sooner or later in the very way in which the child holds her body.
Where self-respect can develop the body will be held easily with an open, upright look of good feeling and good health. Morrison (1994, pp. 19-20) describes some of the bodily effects of shame, the outcome of a history of empathic failure with selfobject mirroring.
Like fog, shame distorts vision and influences what is seen. But more. Shame also feels like a weight, a heaviness, a burden, pressing down often at the top of the back, forcing the body into the characteristic posture ... shoulders hunched, the body curved forward, head down, and eyes averted. The burden of shame can settle into different parts of the body – the pit of the stomach, the face or eyes, or externally, an aura encasing the entire self. ...
Schore (1994, pp. 103-104) describes a model for what he calls a “bioenergetic” mechanism underlying attachment that is entirely congruent with the line of development for self-respect (and the parallel line of development for shame vulnerability) that I am describing. Schore speaks of the “psychobiologically attuned mother” whose interactions with her toddler
involv(e) a pattern of energy transmissions between the mother and the infant.” The mother’s responsive attunement fosters in the toddler an increase in energy and the continuance of an ongoing state of pleasurable activity and being. On the other hand, misattunement “triggers a sudden shock-induced deflation ... In this shame-state, the preexisting activated affects of interest-excitement and enjoyment-joy are suddenly inhibited. (Schore p.212.)
The child’s arousal is diminished, her ongoing movement is stopped, and her state moves into a withdrawal.
The normal development of self-respect is based on respectful, empathically attuned responsiveness from mother and other caretakers. Respectful responsiveness fosters increased energy, affects that are regulated within the child’s interactions with mother and caretakers, ongoing freedom of movement, exploration, interest, and well being, and a generalized state of pleasure. Self-respect emerges and develops out of these states. It is thus a part of the overall healthy development of the self. Disrespectful responsiveness, empathic failures, or misattunement result in shame vulnerability and disturbances in the integrative wholeness of the developing self.
Aliveness, Pulsation, and Self-Respect
I indicated that the essence of selfobject mirroring is an alive, affirmative response of the mother to the child’s aliveness, movement, interest, excitement, pleasure, and the child needing and seeking contact, soothing, and response. In Morrison’s description of the developmental line of shame (Morrison 1998/1996, pp.58 -79), the first step in that line is a basic physiological response on the part of the baby to misattunement. Subsequent steps in his description of the development of shame vulnerability depend upon developing maturational capacities such as the capacity for self-objectification following separation from the maternal matrix, and then the development of the capacity to think symbolically and conceptually.
Once these abilities have developed, contemplation joins emotion and physiological processes to produce an emotion of shame that encompasses all levels of response. (Morrison 1998/1996, p. 79).
I have discussed shame as an example of a “self-hate system” (Helfaer 1998/2006, p.130-32). This expression encompasses all the levels of response in shame. More, however, it reflects the way in which all those levels are integrated within the personality into a functional unity. Shame, and its cousins, are thus complex personality experiences and processes. They are emotions, but more than emotions, because they include not only affect and feeling, but beliefs, attitudes, defenses, and bodily sensations and experiences. They have a developmental history tied to early childhood experience, and they become functional parts of adaptational efforts at all stages of life.
At the moment I wish to focus on the first and earliest step in the development of shame and self respect that has to do with a basic psychophysiological process. Very early in the child’s life, before language acquisition, a baby has an expressive bodily movement that has the qualities that would indicate shame, although without words.
An imagined example: Baby plays happily on the floor; she throws a block with excitement and looks up to Mother with her excitement. Mother does not mirror Baby’s excitement, is annoyed or distracted. Baby shows an immediate break in her ongoing pleasurable play; her energy drops; she looks a bit confused and looks down; her behavior has lost its organization, and she seems to have lost her pleasurable ongoing way of playing.
This is the kind of energetic exchange that Schore refers to in the quote above. Is baby experiencing shame? Her excited play has obviously been interrupted, her movement stopped, and her mood-arousal is depressed. This is a description of what happens in shame. We have good reason to believe that, as Morrison suggests Baby’s experience has a quality of “it’s my fault” (Morrison 1998/1996, p.59). Morrison (1998/1996, pp. 58-59) and others are inclined to call this “an inborn, biological form of shame.”
This “inborn biological form of shame” can be more precisely characterized using conceptualizations of the somatic energetic point of view. What is “inborn” is a basic characteristic of organismic aliveness. This characteristic is expansion-contraction or pulsation. Every living organism from amoeba to humans expand and contract. Expansion happens under conditions of relaxation and safety; contraction happens under conditions of fear, danger, threat, and so on. Expansion-contraction are modulated and balanced by aspects of the autonomic nervous system (Reich ). In the example above, Baby shifted from an expansive phase to a contractive phase.
Shame and humiliation are contracted states, often chronic. Everyone can enter contracted states under stress, fear, shame, or humiliation. The contraction can also last for some time. Self-respect does not protect us from ever experiencing shame, or other contracted states. However, if that capacity is established well enough, it provides a resiliency against such states becoming chronic, and, by and large, allows the maintenance of a more-or-less state of expansion.
The shame-system within the personality puts extreme limits on expansive states. Arousal, excitement, pleasurable states, and sexual arousal specifically are all limited. The shame system functions as a primary mechanism for self-punishment. The effect reaches the cellular level, since the overall pulsation of the organism is derived from the aliveness of the cells. Similarly, a healthy capacity for self-respect, indicating the relative freedom of the individual from a shame/humiliation system, allows for fuller freer pulsation, and a broader range of expansive capacities.

Development of Self-Respect in Therapy
1. Body Awareness, Body Memory, and Body Knowledge
In the therapeutic process, body awareness, i.e., self-awareness, may emerge from body knowledge and body memory, and in that process, self-respect can develop. What I mean by ‘body knowledge’ and ‘body memory’ has to do with what is usually called ‘implicit memory’ which is contrasted with narrative memory. The individual who develops from the disrespected child into the shame vulnerable, shocked, and traumatized individual “knows” a different world from the individual whose overall development is characterized by a healthy self-respect. The one “knows” that she must be very careful in her relationships and in all her behavior in the world; the other can move in the world and express herself with appropriate confidence. Body knowledge is based in (body) memories which influence the development and experience of the self, and yet are not cohesively integrated in the self, especially at the level of feelings and affect. At the same time, they are often the basis for a partial, usually negative, self-identity which is split off or disassociated (a trauma identity) .
For example, the shame vulnerable adult often will have a pervasive sense of inadequacy constantly running through virtually all experience of everyday life. The tendency will be to attribute this sense of inadequacy to flaws of the self they “know” themselves to have, and, as a result they will “know” that this or that person could not take an interest in them, or they were probably a bother to another person. The original sources of this feeling-knowledge will inevitably be found in the disrespect experienced in the facilitating environment of childhood, but these sources will not be available as a part of narrative memory.
For example, the little girl in vignette (2) above is very unlikely to remember the episode in the park in her stroller when her mother ignored her and she was so frantic. Later, however, this same little girl, now an adult, is more than likely to evince all kinds of behaviors and have innumerable experiences which the clinical observer can readily understand as repetitions of this same distress and defenses against the unbearable experience of feeling like the kind of person in whom even her mother has no interest. It might be possible, however, in therapy that through somatic-energetic interventions, she will begin to re-experience these same intolerable feelings as unfortunately being part of her very self. She then will have the opportunity for seeing them as the tragic consequences of being unparented, left in states of distress, and neglected. Then finally, she may have the possibility of experiencing this in the context of her memory of her relationship with her mother. In this case, a body memory would emerge into awareness, and body memory and body knowledge would become self-awareness. She would have a different sense of herself, not as the flawed girl for whom even a mother has no interest, but simply as herself, having respect for herself and feeling she deserves the respect of others. She would have a new, and more enjoyable, body (self) awareness. This process is illustrated in this session from Cindy’s therapy.
2. Cindy’s Therapy
The following is taken from a letter from Cindy to her therapist. I have inserted comments in italics in brackets ([...]).

Fear isn’t the enemy. ... It’s the key. My therapist says, “You’re afraid right now.” I say, “You mean a few minutes ago.” “No,” she says, “right now. Always. It colors everything, but you don’t feel it, the fear.” She suggests I try looking around the room and seeing what bodywork I want to do. I lie on the bed. I am afraid immediately. [Her therapist saw and felt Cindy’s fear; Cindy wasn’t experiencing it, but she was living it as body knowledge: the world is a frightening place.] She asks if I’d like her to work with my neck. I’m confused because I’m busy being afraid. She touches my face very gently and tenderly. I love this and want it very much, but it’s very frightening. I’m afraid that the fear will drive her away [Cindy’s awareness develops further, to understanding and being aware of her fear of having her feelings.] but she stays and I get to have my fear and my awareness and enjoyment of her tenderness. She works with my neck which feels lovely and the fear goes away. She asks where – I don’t know – she says good feelings can make it go away. I have no knowledge if this is true. I suspect she is wrong but who knows. [Cindy has an awareness on a body level of a new kind of possibility, a new case of body knowledge about which she is skeptical because she has not known it, and it is so positive.] Then she works on my back, shoulders, then hips. She asks how that feels. I say good, but I suspect I’m only willing to feel a little bit of the hip pleasure. “That’s where the fear went,” she says. It’s starting to get clear. Fear isn’t just the screaming terror. It can subtly cut down on the feeling of pleasure. [Once again body knowledge becomes body awareness.] She asks if I’d like to try again – being aware of wanting and of the fear. This is hard to do – to keep them both present for myself – but I can sort of do it. ... She goes back to touching my face. I was surprised ... I thought she would rock my hips again. After a while I notice that the sense of tenderness is not so strong and it’s awful ... That must mean that I have that all confused with fear. She says no, the dampened fear has again shut off the pleasure. And I see. She’s right. Allowing fear allows my experience of pleasure. Fear is no longer an enemy, to be locked away. Allowing it is my key to pleasure. It’s not bad. [Her newly experienced body knowledge develops into body awareness and allows her to establish a stronger basis for self-respect: she can trust her body and herself to acknowledge her fear, knowing she will not lose herself, but will find a deepened sense of herself.]

Self-respect is being established in the course of this complex interweaving of experiences, feelings, thoughts, sensations and interchanges – both verbal and through touch – between therapist and patient. It is being established as Cindy is able to allow herself to experience her bodily sensations and the actual experience of fear – and pleasure. The experience is not only accepted, it is respected. As it is respected, there is a shift within Cindy in relation to her own bodily experience. She reestablishes a degree of trust in her own bodily regulatory processes. She sees that in giving in to her body, even with the feeling of fear, pleasure can follow, rather than something terrible, within the context of a trusted, warm connection.
3. Further Lines in the Somatic-Energetic Development of Self-Respect.
In her letter, Cindy describes an encounter with her therapist and – even more importantly – an encounter with herself. Cindy was able to write about the flow of her experience in fine grained detail, allowing us to discern kernels for the development of her own sense of self-respect. The therapeutic setting and her relationship with her therapist can be considered as a facilitating environment. On the occasion Cindy describes so beautifully, she was able to experience feelings and body sensations in some new ways. She experienced bodily sensations of fear, pleasure, touch, and the sensation of dampened sensation. She also felt the interconnection between “allowing” fear and having pleasurable sensation, and the loss of pleasure when fear is dampened; dampening one dampens the other. Feeling comes as a package; it’s the whole package or nothing.
Paying careful attention to Cindy’s description, we are able to envision her interaction with her therapist, her behavior, and her experience almost as if we were actually observing. We see a complex field of interweaving somatic-energetic elements, both objective and subjective. We can sort out some of the elements of that field for two purposes: (1) to illustrate some somatic-energetic processes, and (2) to see what allows for the emergence of kernels for the development of Cindy’s self-respect.
One of my own first observations is that Cindy experienced her therapist as helping her “hold” her experience. This holding has a number of elements. The therapist keeps the focus on body feelings, sensations, and processes; the patient does not “go off” into mental associations. The therapist’s presence and gentle attention enables Cindy to stay calm enough to pay attention to her own feelings without panicking and going off into the “screaming terror” she mentions.
I want to pause here a moment to discuss a specific issue concerning fear. Fear is commonly thought to be a significant element in virtually all trauma spectrum syndromes. It is difficult for self-respect to develop in the face of the constant effort to manage fear when it can escalate quickly, even instantaneously, into terror, panic, or defensive rage or other reactions. A common element in the escalation of fear is what I call the “OMG,” reaction. It is a reaction to a reaction. The initial reaction might be fright or a startle reflex. A reaction to that reaction follows immediately which may be characterized as, “OMG, I’m frightened. Now I’m going to get totally overwhelmed and get terrified,” and then, indeed, the body may very well go into terror. The initial reaction might also be a feeling of sexual arousal: “OMG, I feel something in my genitals. I have to stop it!”
In Cindy’s description, we can see that the way in which she and her therapist connected allowed her to stay free from her usual “OMG” reaction. Cindy was then able to experience her fear in her body in a new way, “Fear isn’t just the screaming terror.” Perhaps for the first time she experienced the actual body sensations that previously have always signaled fear and triggered the “OMG” reaction. This time she identified and felt those sensations in and of themselves, and the OMG reaction was not precipitated, and she was not thrown into the overwhelmed response. This is an important step in the integration of these sensations and feelings.
The holding established between Cindy and her therapist thus allowed her to remain relatively calm. This signifies that her autonomic nervous system did not move into a conditioned reactivity, and in addition, further reactivity did not arise from limbic memory sources. This is an important kind of experience to go through for the healing of trauma spectrum disorders. The body experience, especially body sensations are identified and felt as they are, free from further autonomic arousal and from meanings associated with body (limbic) memory.
In Cindy’s descriptions we can sense a friendliness towards her own bodily experience, also interest, and I believe we can say, respect. These attitudes are the appropriate ones. She is, after all, noticing functions and expressions of her own self. In the facilitating environment of the therapeutic relationship and setting, she has apparently developed the knowledge, that is the body knowledge, that it is permissible and right to have this kind of relationship with her body and herself. Perhaps, this knowledge has been fostered through Cindy’s identifying with or internalizing her therapist’s kindly, caring attitude towards her bodily being.
From this point of view, we can say that some of the moments that Cindy describes are actually self-respect moments. They are characterized by the elements mentioned earlier: noticing and identifying body sensation and feeling of whatever quality; identifying and experiencing without evaluating or panicking; taking an attitude of respect towards the experience. This is a form of holding of one’s own experience that leads to the developmental of self-respect as a basis for relating to oneself. It is the basis for a heightened sense of security and a feeling of safety based on trusting one’s own body. It represents steps in the development of a more cohesive, stronger, and calmer sense of self.
Outcomes
1. Polarities
The development of self-respect in the individual can be seen as a multilayered epigenetic process, the integration of many encounters with the environment over a period of many years. Positive outcomes, in terms of the child’s well-being and natural functioning depend on the overall respectful response of the environment, while negative outcomes ensue in the case of the great variety of possible disrespect that the environment can provide the child in any of the given dimensions and at any given moment of development.
Since the facilitative environment is provided by human parents, not ideals, provision and outcomes are going to be mixed. What emerges in the adult person can be viewed as a matrix of polarities with optimal functioning on one end and more painful maladaptive struggle at the other end. The singular importance of self-respect is that it underlies the positive end of each polarity. These include:
 The capacity for love versus the inclination for ambivalence and hate.
 The capacity to be alone, and to feel lonely, versus the experience of aloneness; the capacity to want to be with a loved person versus hopeless yearning.
 The capacity for sexuality, pleasure, and good feeling versus the tendencies to anxiety, shame, guilt, pain, and shock.
 The capacity for self-care and self-regulation versus self-neglect/abandonment and disorganization/chaos.
These capacities reflect dimensions of experience in the realm of self- experience and also in the interpersonal realm. Each of these polarities functions as an ongoing dialectic within the individual throughout the life cycle. The individual does not emerge at one point and stay there; the polarity remains alive as an ongoing dynamic.
These “capacities,” or their lack, can be appropriately spoken of as ‘body knowledge.’ They reflect how the individual experiences, reacts, and moves in his or her world. A child’s experience is body-experience, and care takers relate to the child bodily. The somatic interaction between adult and child is ongoing. Love, for example, is a natural outgrowth of the child’s pleasurable experience in being with another. In the same way when developmental frustrations become excessive, punitive, and constant, love gives way to ambivalence and then to hate, when the original love, excitement, and good feeling is blocked or turned against. These are simple, organismic realities.
2. Sexuality.
The developmental line of self-respect is inextricably involved with the developmental line of sexuality and the capacity for the enjoyment of sexual love. The two are inseparable. As I suggested earlier, there is no stage in a child’s development at which the facilitating environment is not responding to the child’s sexuality. A respectful facilitating environment does not lose sight of recognition of the child’s sexuality. It is disrespectful, for example, to treat a child as if it were some sort of asexual creature, or to ignore its sexuality as if it did not matter. It always matters, certainly for the child’s development.
Care takers do well for the child when they keep in mind that the happiness of the future adult – now a child, boy, girl, youth – depends on not only their capacity to be a “productive citizen,” but much more on their capacity for establishing a pleasurable, sexual, and loving relationship with a life partner. For this to happen, the child’s capacity for sexual enjoyment and for simply being a man or woman needs to be respected from the beginning. Self-respect will otherwise be deeply undermined.
3. Body Experience and Connection.
Every one of the numerous encounters with caretakers in children’s daily life provide a vast array of multilevel experiences all producing a rich interwoven tapestry of body sensations and feelings. This is the reality of childhood. The capacities to regulate and modulate feelings and behavior develop through adolescence and beyond, and throughout these periods children and youth live the life of the body. The potential for the development of self-respect is also present throughout these periods, and, in fact, I believe that potential remains present for life.
At any given moment, children’s experiences may be held by caretakers in a way which, by and large, promotes the establishment of self-respect. Held this way, such an experience may become a kernel for the development of an ongoing capacity and attitude of self-respect. These experiences are usually accompanied by good feelings, pleasure, well being, comfort, and so on. They tend to promote enjoyment and pleasure in the connection with the caretaker. Conversely, in some encounters, the child’s experience may be held in such a way that will evoke shame, humiliation, or guilt, or establish the tendency toward these states. Usually such experiences are accompanied by frustration and anger, and usually by pain and fear. These moments tend to move the child in the direction of defending, armoring, and distancing connections.
From birth on, the bodily experience ensuing in encounters with the environment arise from every one of the senses. Visual perception, auditory perception, perception of touch, and proprioceptive perception all effect how a baby experiences a particular moment of handling. I believe babies are very sensitive, for example, to the expression in a mother’s eyes. Sad or empty eyes effect baby’s eyes. In Cindy’s description, she is clearly responding to her therapists voice, look, and touch. Touch conveys to Cindy and generally to a child a tone, quality, and energy, just as does the sound of a voice. Perceptions evoke bodily sensations. Variations in sensory quality evoke different sensations and affective and autonomic reactions, creating a field of sensory experience which are part of one experience and are integrated into the meaning and outcome of the experience.
In the two kinds of encounters we are considering – one moving towards self-respect, the other towards its converse – bodily reactions do not remain as simple sensations, or as pleasure/unpleasure, or only tropisms releasing set behaviors. They are the raw materials for multilevel integrative processes which result in higher level “outcomes,” including not only self-respect, but indeed, the mind itself. Through these integrative processes, body sensation becomes feeling, meaning, and definitional attributes of self, other, and world. How this is accomplished in the central nervous system and in the relationships between the various centers of the brain, the autonomic and peripheral nervous systems, and the nearly equally complex endocrine systems is the frontier of the new neurosciences. Perhaps there are developments that are self-contained and inherent to these neurobiological systems in themselves. However, everything that we know of having to do with the outcomes we are examining begin with inputs of bodily sensations which arise in the child’s interaction with the people, objects, and landscapes of his/her environment.
Within this developmental model of outcomes, the issue of trauma enters the picture in the stage of the levels of integration of experience. Generally, it is thought that if an experience is traumatic, there are particular ways in which it is integrated within the brain centers and autonomic nervous systems, and there are some useful researches and descriptions concerning these matters. I will make a few suggestions about this issue from the point of the somatic-energetic point of view later. For the moment, suffice it to say that traumatic experience can, in part, be described as experience whose outcome is to essentially break down the capacity for self-respect. This goes beyond the negative effect of experiences which might establish shame, humiliation, and guilt.
Clearly, it matter immensely to the developing individual how his or her facilitating environment “holds” his numerous experiences. But what else can we say about what determines long-term outcomes for the developing child? What other parameters would it be useful for us to be aware of as therapists or educators? Here, I am concerned about the favorable long-term outcome understood as a young adult with an established, ongoing self-respect. The less favorable outcome is the young adult more dominated by shame, humiliation, guilt, and even self-hate, or whose capacity for self-respect has been traumatically curtailed. Our therapeutic encounters tend to be with individuals who fall in the second and third category, where experience is dominated by shame vulnerability and/or trauma.
Whatever we might say about a specific encounter at a specific moment, there are no simple formulas. Most long term outcomes are usually mixed, complex, often ambivalent, and often oscillating between self-respect and deficits in self-respect. Realistic, common sense knowledge of family life suggests that these may, in fact, be more the rule than the exception. Finally, events or life periods which are traumatic for the child may carry far more weight in
development than periods of life which are more or less neutral or even slightly favorable for developing self-respect. This is the nature of the effects of traumatic experience.

Aggression, Self-Respect, and Selfhood
Self-respect, as what I am calling an “outcome” is one aspect of the overall development of the self. Self-respect does not develop by itself, separate from other attributes of selfhood. As described earlier, self-respect and sexuality, understood as an intrinsic aspect of selfhood, develop in tandem. Now I want to mention something more about self-respect in relation to the overall sense of self, and more specifically how aggression enters the picture.
In this discussion I use the specific conception of aggression presented in, The Dynamics of Human Aggression, by Anna-Maria Rizzuto, W.W. Meissner, and Dan Buie (2004). These authors have elucidated a paradigm for psychoanalytic theory that is observationally based in clinical experience which solves two unsolved problems in psychoanalytic theory: the problem of aggression and a replacement for drive theory.
They define aggression as an inherent biological capacity of the individual to address and overcome obstacles in the way of meeting motivational needs. In this sense, aggression does not necessarily imply either anger or destructiveness. What counts as an obstacle may be either an obstacle of the individual’s internal world or an obstacle in the outer world. The biological capacity of aggression makes use of any and every resource at the individual’s disposal. In their sense, a defense mechanism is an expression of aggression.
Drive theory in their paradigm is replaced by a motivational theory with the self being the agent of action.
Self-respect may be looked at as the fundamental healthy way in which aggression is organized as a dynamic ongoing function. It allows for the facing of obstacles of all sorts without suffering diminishment of selfhood on too great a scale in the face of inevitable life difficulties and suffering. It is also a strong basis for resiliency and restoration when selfhood is threatened or diminished, as it inevitably will be, at times. Self-respect is the basis for allowing the individual to matter to him or herself, to keep his or her own motivations in the appropriate perspective, neither losing him/herself in egocentrism nor other-orientation.
When states which are the mirror converse of self-respect – shame, humiliation, guilt and fear – dominate the individual, the capacity for facing and overcoming obstacles is diminished, often on a major scale, and resiliency also is greatly diminished. Furthermore, the development of the negative states tend to generate anger, frustration, and fear. These states divert a great deal of energy both in themselves and in the demands they impose for defense and adaptation in relation to them. They do not support self-efficacy, and they deplete energy and capacities. Trauma, as mentioned earlier, breaks down self-respect, and in essence represents a greater or lesser degree of degradation of the entire capacity for aggression.
When the developmental outcome for self-respect is less than optimal the individual’s capacity for aggression is diminished. All kinds of complexities and developmental disturbances evolve in this situation. Self-efficacy or competence is diminished, leading to all kinds of indirect, complex ways to satisfy basic motivational needs, adaptation, and some degree of fulfillment in life. Resiliency in the face of life difficulties and energy available for pleasurable, productive use are diminished. The sense of self is prone to be overtaken by negative identity formations and negative introjects. Anger and frustrations further diminish capacities and energy and intrude into consciousness. Shame, humiliation, frustration, fear, envy, and anxiety predominate. Finally, rather than be the center of his/her own world and defining his/her own way of being in life, in a peculiar way, the individual is diverted from him or herself to make the center of gravity focused in the other. This development, in particular, is the virtual enemy of self-respect.
We can consider an example of these developments from the Oedipal period of childhood. I believe this period of development is more appropriately defined as the period of the identification with the genital. Common developments during this period can have the outcome that in adulthood, feelings of sexual love or longings for sexual love actually become in themselves a kind of “obstacle.” This kind of development is usually precipitated by some kind of rejection, disapproval, punishment, overstimulation, or other abuse of the child’s love, excitement, and sexuality by one or both parents. This kind of disrespect of the boy or girl is deeply painful, essentially traumatic, and formative. Subsequent developments, involving a number of steps, result in sexual desire and the actual longing for sexual love becoming a signal of something painful and/or dangerous, and therefore they are “obstacles.”
When this developmental outcome occurs, aggression is mobilized, drawing on a variety of somatic-energetic and psychological resources to overcome the obstacle. This secondary, defensive, development results in a wide ranging transformation of the overall expression of sexual love and sexuality, generally. Here sexuality refers to the particular characteristic way in which the man or the woman , feels him or herself to be a man or woman, his or her inner experience of his or her maleness or femaleness, and the way in which this is behaviorally expressed.
We can look in more detail at some of these steps in the case of the male child. As an adult, he is faced with a situation in which any evocation of sexual love and desire threaten to evoke the experience of the childhood trauma. This immediately places sexual love and desire as an obstacle. They are obstacles to the maintenance of positive self-regard and they threaten the individual’s integrity with anxiety, fear, shame, and guilt. Paradoxically they are a threat to any feelings related to masculinity. Aggression will long since have been mobilized, however, to deal with the initial injury or, as I call it, violation of sexuality. The resources mobilized to deal with this kind of injury usually result in its absence from awareness.
The development of sexual wishes, desires, and gratification will nevertheless develop. From this point on, and that means from the very beginning, resources will be mobilized to organize sexual expression in such a way as to protect, gratify, take revenge, and preserve some preferred way of finding gratification, and maintaining a masculine identity. All of these transformations require energy and adaptational modes of being and expression. The result is the not uncommon hardening or armoring of the expressions of love. The “obstacle” posed by more tender longings and feelings are thus overcome.
Each item in this transformation and expression can be examined therapeutically, the hardened form of sexual expression and its various components, anger, hardness, revenge, inflicting pain, and so on, and similarly, the suppression of the softer feeling of sexual love may emerge with its history of rejection and castration. Finally, it would be hoped, that the pain of the original rejection or abuse will be recognized and felt for what it was and integrated in a cohesive way in the self. Each of these issues and processes will have somatic-energetic as well as psychological expressions.
Self-respect is lost as a central focus in this kind of development, and while the adult may be functioning in a way that can be described as “self-centered,” he or she has really lost his/her center. The center of the self that is driving behavior is the original injury or trauma, and in dealing with the injury, the individual essentially depends on a manipulation of the other. The fulfillment of the self becomes an effort at having the other conform to a pattern that will relieve the early injury. This never succeeds, and the individual is lost in preoccupation with managing the other.

N, a woman in her late fifties, expressed this loss of self very graphically and with a kind of black humor. She said, “I donated my body to science.” She was referring to the way in which her father had made her into a kind of erotic toy for his own enjoyment, while her depressed mother was in bed in another room.
The Importance of Self-Respect
1. In relation to the functioning of personality.
The descriptions and analysis so far presented reveals self-respect to be a central function in the somatic-energetic and psychological processes of personality. This conception of self-respect is not merely a psychoeducational tool to promote an uplifting state of mind. Neither is it an idealized distant goal of psychotherapy. It is organically and functionally a part of the developmental stream, beginning at birth, that also involves aggression, the sense of self, and sexuality. Its sources in development are found in the particulars of intimate bodily-emotional-sensory-perceptual experience flowing continuously within the relationships and settings of the facilitating environment from birth onward. At all periods of childhood, adolescence, and youth specific dimensions of the facilitating environment can be analyzed and understood in terms of respectful or disrespectful functional properties of contact, holding, nurturance, support, and sexual response.
Within the adult person, self-respect is a fundamental, functional dimension or principle. When established with some stability, self-respect is reflected in the person’s functional management of ordinary life and resilience in the face of difficulties and suffering. When it is not established well, there is much more struggling and suffering. In these regards, it is a criterion of health.
2. Case of D.
The following vignette is of a patient in intensive analytic therapy, as described by her analyst. This is a picture of catastrophic failure in the development of self-respect.
D is a 35 y/o woman, married with children. She has been in intensive analytic therapy for two years. What is outstanding about her therapy, as her therapist describes it, is her insatiable demands for a kind of physical parenting from her analyst. She insists on hugging her analyst when she leaves, she makes demands for holding and touching during the therapy hour. She has managed to get her analyst to extend the length of her customary analytic hour from fifty minutes to a full hour, and even then claims that leaving at the end of the hour is unbearable. All these demands are made with an unquestioned sense of entitlement. When her analyst suggests that the basis for their work is talking together about her demands and professed needs, D replies that if her analyst would give her what she needs, she could proceed to “grow up” on her own.
D’s demands, entitlement, and constant complaints of narcissistic injury have become an unpalatable burden for her analyst. Even worse for the analyst, D herself is unpalatable. As much as D seems intent on swallowing her whole, her analyst very much would like to divest herself of D altogether. The analyst, it should be mentioned, is a very experienced senior figure, who has a gentle, warm, feminine personality, and is entirely capable of empathy for D, even considering the possibility that perhaps D is correct, in a way, and asking appropriately for what she really needs. To add to the analyst’s difficulties in the way D functions, or refuses to function, in her therapy, her analyst – understandably, it seems – finds D, (resorting to a euphemism), physically unpleasant. D is obese and smells. When D embraces her analyst, she likes to burrow her nose into her neck and smell her, perhaps inhale her would be more accurate.
I understand D’s behavior as the expression of a catastrophic failure in the development of self-respect. D’s shame and humiliation, we can infer, is monumental. Her obesity and lack of cleanliness express serious self-neglect, a disregard and negativity towards her own body. Her insistence and imposing her needs on her analyst show an utter disregard of the person of the analyst, reflecting, I believe, a lack of cognitive development of the conception of respect for self and other.
What is most important, I believe is that her insistence on the reality of her needs and her ideas about the necessity of those needs in relation to her analyst point to a pervasive lack of contact with herself emotionally and bodily. I understand her behavior in relation to her analyst as a desperate attempt at rescuing herself. I believe she is trying to rescue herself from monumental shame, humiliation, and an underlying catastrophically degraded negative sense of herself. D, at this point, does not have an awareness of these underlying feelings.

When optimal outcomes for self-respect are compromised, the capacity for aggression is compromised. When the capacity for aggression is compromised the development of the person is pervasively compromised. Self-efficacy, competence, and the sense of self, including self-identity are undermined. Functioning stably with satisfaction in the world of sexual love and connection and establishing a family are likely to be more than ordinarily difficult. If the individual is talented, she may be able to establish herself in a work life that is largely fulfilling, but her sense of her personal life and being may have a quality of chaos, disorganization, or lack of boundary.
3. Question as to basis for the claim to significance.
If self-respect is – as I am claiming – such a significant dimension in personality functioning and in the therapeutic process, why has it not been already recognized in the vast literature on the different kinds psychotherapies? The question deserves consideration. Perhaps my claim is overstated.
I will address the question first by describing two examples of psychoanalytic constructs which have in their intention and function something that begins to approximate the construct of self-respect as I am developing it. Both examples have been acknowledged as significant contributions and they are both from acclaimed scholars. I will then mention two more examples from other fields.
First, I must mention that within psychoanalytic theory, the concept of self-respect would fall in the realm of “self-relations” (White, M.T., 1980). This realm has not been explored, as far as I know, to the extent that “object relations” has, the influence of relationships in development, the relationships amongst the “objects” of the inner world, and the dyadic field of the therapeutic relationship. The original statements in this field concerned the management of “self-esteem” as an aspect of narcissism and narcissistic self-regulation (White, M.T., 1980).
My first example is Andrew P. Morrison’s work on shame which I have already introduced. His exploration of shame in his book, Shame, the Underside of Narcissism (Morrison, 1989), is a sophisticated elaboration of issues relating to self-esteem and narcissism. At the end of his book, Morrison suggests,
[I]t is possible to turn more frequently inward, to oneself and to affirming objects, for the nod of approval or acceptance about ourself or our efforts ... Finally, through that inward gaze, we can attempt to transform the harshness and severity of the ego ideal into a more accepting, attainable ideal self. ...

Turning the potential control of shame inward is an important developmental step ...[and would result in] the creation of firmer self-structure. This internalization might then allow for a firmer establishment and control over sources of self regard and shame ... . (Morrison, 1989, p. 182-183).

In these lines, Morrison does seem to be suggesting a kind of function within personality that approaches my concept of self-respect. Unfortunately, he does not arrive at the point of suggesting that this process might be considered an aspect of development from the beginning, a development which would establish an inner institution different from the harsh, severe ego ideal, the source of shame. Such an inner institution, that is something akin to self-respect, would provide the kindly guidance Morrison suggests might be possible.
I suspect that it is not coincidental that these ideas appear at the end of Morrison’s book. As it is, he made a great, pioneering contribution. Working within the current framework of psychoanalytic theory and technique and with his own clinical knowledge, he advanced a conception of a fundamental human experience and function that lies at the center of psychotherapy. His thoughts at the end of the book point the way for a further stage of development within the field. Unfortunately, this was as far as he got.
The second example of an important psychoanalytic formulation that approaches the somatic-energetic concept of self-respect is the work of Dan Buie (Buie, 2004). To my knowledge, Buie has not published this material, and my description of it is from notes I took in a course he offered. Buie is a senior figure in psychoanalysis, especially known for his work with personality disorders, and the course I took with him was on the psychotherapy of these conditions. His thesis is that there are five essential psychological functions which are necessary for the survival and equilibrium of the self. He calls these self-maintenance functions. Thy form more or less of a hierarchy of maturity. I describe them very briefly.
1. A felt sense of realness is the capacity to experience one’s own realness in one’s own right or with another.
2. A sense of being securely held. That is one can feel as if securely held when by oneself, as if one were still in a secure togetherness.
3. Self-esteem: the capacity to experience one’s self as having worth.
4. To have self-love, is to have a warm regard for one’s self and one’s surrounding world, continuing within the self the kind of attitude or feeling that came with receiving unconditional love as a child.
5. A positive sense of identity includes a sense of one’s self as a cohesive whole and a sense of belonging in relation to significant others and within significant groups.
Failures or deficits at any level of this hierarchy create functional and adaptive difficulties.

Buie’s self-maintenance functions express forms of positive self-relation, and in that way are similar to self-respect. Just as with self-respect, an appropriate therapeutic relationship can help to restore deficits or distortion in any of the psychological self-maintenance functions. As with self-respect, the self-maintenance functions are not learned in cognitive apprehensions. They must develop in the context of a facilitating environment, either in psychotherapy or in life, but through repeated experiences of immersion in relationship. Self-respect, I might say, as a body concept perhaps underlies the establishment of each of the self-maintenance functions.
Buie’s self-maintenance functions and the suggestions Morrison makes at the end of his book seem to me to move in the same direction as the concept of self-respect. These are all functions and processes allowing the individual to adapt and meet life difficulties without serious loss of well-being, functioning, or development of a trauma spectrum syndrome. Psychopathology develops when the individual who has deficits in these functions meet undo stress. When that happens and the individual seeks a somatic-energetic therapy, the therapist can manage the relationship and therapeutic interventions having in mind the re-establishment or repair of self-respect. This can be done in the course of helping the individual to regain contact with him or herself through his or her own body.
The work of Buie and Morrison, within psychoanalytic theory and technique, are two significant investigations that present approaches which are quite similar in meaning and intention to my construct of self-respect. Both suggest functions and processes within personality and psychotherapy similar to those of self-respect.
I will mention two other examples from other fields. We can find related developments within the field of cognitive behavioral therapy. In “third wave” cognitive behavioral therapies, the concept of ‘acceptance’ has taken a central stage, as the whole cognitive therapy paradigm has developed and changed (Hayes, 2004).
Finally, from the academic, scientific psychology context, comes an exciting development that I consider precisely congruent with the construct of self-respect. This is the work on self-compassion of Kristin Neff (2011). Neff took the Buddhist conception of self-compassion and put it into the western, academic, scientific tradition with full success. Neff and colleagues established trainings, research scales, and outcome studies demonstrating significant benefits. Self-compassion is entirely compatible with self-respect. It is based on acknowledgement, recognizing common humanity, and feeling compassion toward one’s own specific experiences or attributes. One of the exciting aspects of self-compassion is that, while it is not specifically grounded in body experience, it is an experiential practice, and as an ongoing mindful practice, it can facilitate the establishment of self-respect, and vice versa, self-respect is a grounding and foundation for self-compassion.
Self-respect, as I have said, is a body concept. This is where self-respect differs from each of the four fields I’ve briefly described. It is based on body sensation, body feeling, and moment-to-moment body experience. It develops from birth onward, based on the immediate experiences of each and every interaction within the facilitating environment. Neuropsychologically, it has a basis in limbic, or procedural memory, and thus has the quality of “body knowledge.” This means it is implicit in the way the individual experiences himself in the world. It is a capacity that, ideally, is established and developed from the beginning in an ongoing way, or that can be established later on through experience and intention.
Finally, we can return to the earlier question. If self-respect is such a significant concept, why has it not been introduced up to now as a basic concept? The work from other fields that I have presented that is similar in intent and function to the concept of self-respect is also very recent, including, in psychoanalysis, the work of Morrison and Buie. It is only recently that the conceptual materials available to psychoanalytic thinkers might have allowed for the creation of this or related concepts.
The shifts in the cognitive behavioral therapy paradigm mentioned are also recent developments, as is Kristin Neff’s work on self-compassion. All of these developments suggest a cultural shift. This general cultural shift seems to have carried over into the zeitgeist of the psychotherapy world. The ground now seems prepared for such concepts. In the simplest terms, there seems now to be a readiness to broaden and deepen the conception of the self beyond simple notions of self-esteem, narcissism, or ego orientation. I discuss this trend below.
However, there is one qualification to these conclusions. Self-respect, I insist on emphasizing is a body concept. It is only in the somatic-energetic therapies that two conditions are present which permit the introduction of self-respect as a body concept. Those two conditions are (i) the self is considered as a body self in its entirety throughout the life span, and (ii) the therapy involves interventions in which the body is directly addressed. Only with these two conditions does self-respect make sense as a body concept in therapy. Since these two conditions together are not met either in cognitive behavioral therapies nor in psychoanalytic therapies, it was not possible to develop the concept in either.


4. Self and Other; Self or Other
I introduced the observation that a cultural shift in the conception of the self is occurring that allows for a deeper and expanded understanding of the self, and this shift is entering into the psychotherapy world. I mentioned that up to now, the whole area of self relations has not been developed to the extent seen in object relations theory. I believe the lack of a developed focus, or a confusion about such a focus, on the relationship with one’s own self has cultural sources. To this day, there is a deep ambivalence in society regarding even the idea of self-development. It suggests selfishness, egocentrism, narcissism, and greed; it suggests a lack of sense of the other and of community. There is much popular and psychological writing about the narcissism of our culture. This is too big a subject to explore extensively here, other than to point to the issue as a source of the ambivalence within the culture that would tend to restrict the focused development of a concept like self-respect.
Apparently this ambivalence dates to ancient times. The following utterance is traditionally attributed to R. Hillel, first century B.C.E. rabbi, sage, and leader of a school of Judaism:
If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when?

I would love to know all that had been in Hillel’s mind that prompted him to formulate this remarkable utterance thousands of years ago. Whatever prompted him, or whoever it was who first uttered it, this saying seems to capture a dilemma of human existence. How does a moral, empathic, and compassionate person take account of and responsibility for him or herself and at the same time fulfill responsibilities for others? At times, these ends conflict. In my own world, am I to put my own priorities first? If I do so, what kind of a human being am I in relation to others, (and, for that matter, myself)? If I do not do so, the same question can be asked, What kind of a human being am I in relation to others then, (and, again, for that matter, myself)?
In one school of Judaism in late eighteenth and early nineteenth century Poland, the formulation of this dilemma shifted in an interesting direction. For Przysucha, his successor, R. Bunim, and their tradition, the emphasis in spiritual development shifted in the direction of the more difficult and ultimately most valuable, as they saw it, development of the self (Rosen, 2008). From that tradition arises the following remarkable utterance which contrasts with Hillel’s formulation.
If I am I because I am I, and you are you because you are you, then I am I and you are you. But if I am I because you are you, and you are you because I am I, then I am not I, and you are not you. (Rosen, 2008, p.144).

Here is a position which seems to unabashedly support the development of the self and, possibly therefore, a conception of self-respect. Further, it seems to do so with the unequivocal placing of one’s own self as the center of one’s world, and one’s own development as the first priority of that world. Does such a position have implications that cannot be supported by an ethical, compassionate, and related person? To be fair to the Przysucha tradition, I should clarify that in fact the self development they sought was indeed for the purpose of relationship: the individual’s own relationship with God. However, as far as relationship with other people went, this tradition moved away from the dilemma posed by Hillel.
The dilemma posed by Hillel questions the ethical validity of placing one’s own self at the center of priorities, and it also recognizes that not putting oneself at the center of one’s own priorities leaves one desperate: “If not now when?” This sounds to me like, “Help!” R. Bunim’s tradition takes that quandary further and into an even more desperate place. If I am not for myself now, then I am not even authentic. And that is the worst place to be because then one is not in a right condition to relate to the divine power, and presumably to others either.
I believe thinking and morally sensitive people are today, outside the context of religious tradition, still ambiguous and ambivalent in relation to these questions. Evidence for this is to be found in Carol Gilligan’s study, In A Different Voice. Gilligan documents awareness of the dilemma I am describing here in some of the subjects of her study. Her study also illuminates the resolution of the dilemma. Her young women subjects first of all came to realize that their ethical development depended, in fact, on the development of their own self, and that secondly, significant decisions had to be made taking that self into just as much account as the self of the other. They realized that, in actual life, any significant decision involved the other, and also that living in relation to the other required that they had to assume equal responsibility and care for one’s own self. What had to be recognized was their interdependence, their self with the other’s.
This level of moral development, reflecting and valuing interdependence and based more in caring for and about relationship than abstract principles is probably still not common in our world. More common, I would believe is a morality emphasizing absolute values or principles, and a conception of the independent self, separate from and amongst others. Nevertheless, given all these layers of ambivalence regarding the meaning of selfhood in our world, there is such a thing as self-respect. It is a central and functional aspect of the development of personality, and it carries functional significance and developmental possibility throughout life. Like all major aspects of personality it develops in the flesh and blood intimacy of the relationships of the facilitating environment. It develops in these interdependent relationships and at the same time is part of the foundation of separation, individuation, and self-identity.
In its mature forms self-respect is part and parcel of the capacity for the respect for others, and, in fact, it is hard to understand how respect for others is possible if one does not have respect for one’s own self.
I am describing a confusion and ambivalence that has influenced cultural understanding of the self and relationships from time immemorial. This confusion and ambivalence permeates common feeling and thinking about matters of morality and ethical decision making. Individual adaptation reflecting these issues varies from self-centeredness of various forms, including what might popularly be considered narcissism, to ideals of self-sacrifice and always focusing on the other. I am discussing this whole matter because it seems to me that these confusions have influenced psychologists and psychotherapists to direct their attention away from perception of the obvious functioning of self-respect within healthy personality functioning and away from attempting a formulation of this concept. This, I am claiming, is part of the answer to the question why the concept of self-respect has not been formulated simply and clearly heretofore.
I have attempted to show that self-respect is part and parcel with the development of the self, reflects a process having to do with one’s own relations to one’s self, and it develops in the context of relatedness. These two fundamental aspects of human functioning and development are a polarity of human experience which has been described by a number of psychological theorists, especially, for example Angyal (1965) and Blatt (2008).
5. Culture, Shame, and Self-Respect
Mature forms of self-respect are fragile developments. The whole development of self-respect, as with self identity generally, is very easily usurped by various group allegiances – family, tribe, political affiliation, religious sect, nation, or virtually any other powerful group affiliation. Then family, leader, group, or sacred object is the object of respect. They are, or represent, the higher values, the idealized objects.
Idealizations lead to (and may arise from) degrading attitudes toward the body and towards sexuality, women, and the softer, gentler aspects of human experience. Respect for the mere bodily self is relegated to insignificance or less than insignificance, a kind of meaninglessness apart from the identification with idealized objects. This kind of societal development supports pervasive individual shame and humiliation and a personality development in which there is a pervasive psychological and dissociative denial in relation to the body and the feelings and sensations in the body. The body, as the person, becomes an object or tool for external societal aims. The suicide bomber is only the most horrifying and extreme example in today’s world.
Under these conditions the others who do not show allegiance to the same objects of respect are subject to every sort of degrading devaluation of body and soul. These attitudes ultimately justify devaluation, subjugation and even annihilation of the other. Thus, it seems to me that peaceful coexistence and cooperation depends on societies which foster self-respect in its basic manifestation: the individual’s respectful awareness and attention to his/her own bodily being as the center of individual human and therefore group life.
Shame and humiliation are powerful hidden variables in the issues I am discussing in this and the previous section. Shame and humiliation, as I have mentioned, are negative conversions in what otherwise should be the development of self-respect. They are the functions that develop when outcomes for self-respect are negative. By their action, they throw light on the meaning, function, and importance of self-respect.
Shame promoting culture is widespread. It is not a characteristic only of societies dominated by tribal politics and non-democratic government. When Andrew Morrison wrote about The Culture of Shame (Morrison 1998/1996), his main cultural reference was the United States. Indeed, all the writings about narcissism in relation to contemporary culture, the “me-too generation,” and so on, are explicitly or implicitly references to the powerful tendency of our culture to foster family and developmental processes that lead to the individual being susceptible to, and often dominated by, shame and humiliation. It would take deep seated changes in culture to provide support for family and individual development facilitating basic self-respect.
Self-Respect and Trauma
1. Impact of Trauma on the Self.
Virtually all studies of trauma describe the destructive impact on the self and the psychophysiology of the self. Different language is used by different writers, but they all point to the same thing. This nearly universal perception is stated in study after study. In the literature of recent decades we find the following.
Traumatic events … shatter the construction of the self …
… the traumatized person loses her basic sense of self. (Herman1992/1997, pp. 51-52)

At present, trauma experts consider pathology of the self to be the main adverse phenomenon in trauma patients. (Aarts & den Velde 1996, p.371)

Virtually all studies document the damage to self-esteem and self-worth, in other words, there is a universal recognition of shame, loss of self-esteem, and humiliation in posttraumatic development. Solomon refers to the “radical loss of self esteem,” and the “agonies of shame” in soldiers who have suffered Combat Stress Reaction and/or subsequent PTSD (Solomon 1993, pp. 167, 236).

Most traumatic experiences are associated with feelings of shame and guilt … (Turner, McFarlane, and van der Kolk 1996, p. 543).

Shame is an integral part of traumatization … (van der Hart, Nijenhuis, & Steele 2006, p. 290).

The most poignant documentations of the shame and humiliation, as well as the fragmentation and disassociation, that accompany the survivor through his/her life are those found in personal memoirs such as Denial by Jessica Stern (2010). Maryanna Eckberg, a pioneer in the use of somatic-energetic therapy with trauma survivors, writes in her memoir, “What does it mean to have your identity completely destroyed at age twenty? This is a question that still haunts me” (Eckberg 2000, p.209).
Earlier, I noted that the “third wave” (Monson, Friedman, & La Bash 2007, p. 47) of cognitive behavioral therapies integrates concepts such as self-acceptance and self-compassion, implying its recognition of their lack in trauma survivors.
Finally, in studies of the prevalence of PTSD in various communities post- 9/11, current low self-esteem was found to be associated with PTSD at both one year and two years post-9/11 (Neria, et.al. 2011).
Whether trauma occurs in childhood or later life, there is a universal recognition of the destructive impact of trauma on the self. In this hasty survey, that impact is reflected in posttraumatic outcomes having to do with shame, humiliation, and the sense of self generally. Of course trauma, developmentally as well as in adult life, casts a much wider net. Studies of trauma spectrum disorders invariably include effects on character pathology, psychophysiology, (arousal disregulation), on interpersonal relationships, cognitive functioning, mood (depression and anxiety), and on sexual functioning and sexuality (feelings about masculinity or femininity). Subsequent posttraumatic syndromes may evolve into disassociation, and other disturbances of consciousness (flashbacks, nightmares), and somatic illness. All these disturbances also reflect the destructive impact on the self.
2. Relevance of Concept of Self-Respect: Therapy
Focusing, for the moment, on shame, humiliation, and sense of self immediately draws attention to the possibility of a continuity with our previous discussion of self-respect and its converse developments, shame, humiliation, and so on. I am not implying that shame/humiliation should be seen as either the primary outcomes of trauma exposure nor the cause of PTSD. What is suggested is, first of all, that shame vulnerability and humiliation vulnerability can perhaps be understood as part of the spectrum of the trauma syndromes.
Similarly, the developmental model described earlier can be directly useful in understanding the trauma spectrum.
I will examine the relevance of the concept of self-respect to understanding trauma from two perspectives. First, briefly, from the perspective of psychotherapy. Earlier, I described a therapeutic experience of my own in which an experience of self-respect emerged. That experience held a lot of significance for me then, and it continues to. It was one of the kernels of experience that became the basis for healing, putting my sense of self on a firmer footing, and certainly in helping the alleviation of the suffering of shame/humiliation vulnerability, self-hate, and a negative trauma identity. My experience arose in the therapeutic relationship I had at that time, and, in retrospect, as I mentioned, I believe it was facilitated in part by a particular quality of the therapeutic stance of my therapist. I characterize this as being an attitude of respect for the organismic being (the body) of the other that was a consistent and inherent aspect of my therapist’s characteristic way of functioning in the world.
I believe this quality is an essential element in a therapeutic stance in working with traumatized people. This quality comes through in the writing of Maryanna Eckberg (2000). She does not spell it out explicitly, but it illuminates all her descriptions of her work with her patients, and it seems equally clear that her patients respond to this quality. It is clear that she has a sensitive and differentiated awareness of the what is going on in the bodies of her patients. “All survivors with whom I have worked manifest a certain basic physical and energetic organization, referred to as a shock organization” (Eckberg 2000, p. 45). In working with survivors of political torture from Central American who had taken refuge in the United States, she would tell them that they did not have to talk. She could then work with them using basic bioenergetic (somatic) techniques of breathing and grounding until they felt safe enough with her to begin talking about what had happened to them.
Initiating the re-establishment of self-respect, I suggest, is one of the important mechanisms that is the basis for the patient to begin to feel a degree of security with the therapist. I would also suggest that it is a mechanism that is essential to the building of the therapeutic relationship. It is not necessary that the therapist actively do something for these processes to take place in the therapy. What is necessary is that the therapist embody the attitude of self-respect. This means self-respect is an essential, implicit, characteristic way of being on the part of the therapist. It is not spoken, it is lived. It finds expression in attitude and as part of characteristic self-expression. Self-respect is thus inherent in the way that the therapist looks at, listens to, and is with the patient. The patient is experienced not only as another psychological being – mind and soul – but, additionally, with respect for her somatic-energetic being. From this state, the therapist’s empathic understanding of the patient includes the awareness that the therapeutic process, the healing journey, hinges on the patient’s own developing or reclaimed capacity for self-respect.
3. Relevance of Self-Respect in Traumatization.
What happens to someone at the moment he or she is actually traumatized? The perspective I developed in this paper can shed a little light here and there on some facets of this huge question. To begin with, I will put the question into a manageable context. What happens at the moment of traumatization is extremely particular in every case in terms of the external setting of the trauma. Medical trauma, accidents, personal assaults, and military combat all present different contexts and settings and each particular instance in any one of these settings is unique. Furthermore, for the most part, there is no way of knowing if a particular event in an individual’s life is “traumatic” or in what way until after the fact. A very minor automobile accident, for example, can set in motion a posttraumatic stress reaction which evolves into a very serious set of seemingly inexplicable somatic problems (Scaer 2001, p.xvii -xix).
On the other hand, Eckberg describes a fascinating treatment with a woman who had a very serious bicycle accident, following which she developed typical PTSD symptoms. In most cases, these sets of symptoms are similar. In other words, the woman who developed serious PTSD after a car accident in which the car was going 5 mph, had symptoms very similar to the symptoms developed by the woman who nearly died in a bicycle accident.
These observations point to another important observation. In the development of PTSD, for example, there are two phases. There is whatever it is that happens to or in the individual, and then there is another subsequent process during which various other symptoms emerge. I am asking about the first phase. What happens at the moment of traumatization? Knowing something about this should also help understand the subsequent developmental phase. What kind of information is there about this?
In fact, there are many detailed reports of personal trauma from individuals, and there are also observations by others. In the case of the woman who had a terrible bicycle accident, several aspects of the experience emerged in the course of her therapy. She recalled the feeling that her hands and arms were “impotent.” She had the terrible feeling that she could not stop what was happening. Most remarkably, she recovered a near death experience; and she recovered the experience of the terror of annihilation at the moment she began to fly off of the bicycle.
Another graphic account of what happens to the individual at the moment of traumatization is found in Zahava Solomon’s riveting study of combat stress reaction (Solomon 1993). While combat stress reaction unquestionably lies within the trauma spectrum, it is not the same as PTSD. Not all soldiers who suffer CSR develop PTSD, although many do, and not all soldiers who develop PTSD have experienced CSR. In CSR, the soldier breaks down and can no longer function. Inevitably this occurs during actual combat. While the symptoms vary, Solomon states clearly that “what is behind most, if not all, of them (symptoms) is the fear of death” (Solomon 1993, p. 32). Besides uncontrolled anxiety, the soldier may experience numbing, extreme vulnerability, loss of control, and extreme helplessness. All in all, it is a horrible state, and other symptoms soon emerge following removal from the battlefield, depression, guilt, and radical loss of self-esteem.
In the vignette described earlier, the little girl crying so frantically and reaching out for her unresponsive mother, we also observe a kind of breakdown. While the setting was not a battle field, it was clear that this little “soldier” was experiencing something thoroughly akin to what soldiers experience in CSR. She was profoundly frightened, out of control, helpless, and completely alone and vulnerable. She, too, was no longer functioning as normal, as a healthy little girl.
In this particular experience, the mother’s behavior in relation to her child has gone beyond misattunement, or failure of mirroring. This child is not simply momentarily distressed, mildly interrupted in her play, and showing a response like a shame reaction. This reaction has taken the child into a psychophysiological state different from a shame reaction, and this state causes a more radical breakdown of normal functioning. At the same time, this child’s experience can be seen on a continuum with more “normal” failures of attunement.
Like a normal shame response, the child’s ongoing self-motivated behavior is stopped, although in addition to being stopped there is another dimension of a kind of breakdown. This experience is overwhelming. It overwhelms the child’s appropriate and ongoing developmental aliveness. In this sense, the traumatizing stimulus is “disrespectful.” In the case of overwhelming experience, the “disrespect” takes the form of being at odds with the evolutionary biology of the organism, to the point where it threatens its ongoing capacity to function, develop, or go on being. The child, the CSR soldiers, the woman who nearly died in the bicycle accident – all were thrown into an experience and situation for which their biology had no functional adaptational preparation. When death does not result in these circumstances, the individual experiences terror, helplessness, and dissociation.
In traumatically overwhelming experience, the individual is blasted into an experience and a situation for which the body has no functional adaptation. This statement invites an important qualification. It is more correct to say that all kinds of adaptational responses may be triggered within the neurophysiology of the body, but they are not functional in the given situation. The sympathetic autonomic nervous system is activated, but there is no possibility of fight or flight, throwing the body into chaos and freeze. Similarly, evolutionary early forms of learning are set in motion – of the sort connecting fear and a dangerous snake, for example. In overwhelming experience, however, the conditions result in all kinds of connections which tend to emerge as PTSD symptoms – numbing, dissociation, fragmented and partial memory, and so on. Some of the neurophysiological basis for these terrible outcomes have been fairly well described and are still being studied. However, the result is massive disorganization of personal functioning.
Shame/humiliation are the result of distorting self-respect into a kind of converse of itself, a negativity in relation to the self, modulating aliveness, movement, and feeling. Traumatizing experience, on a somatic-energetic level destroys the functioning of self-respect. In the model I am describing, we noted that self-respect develops and functions in conjunction with aggression and sexuality. Aggression, as a general form of the biological adaptive capacity of the organism, allows the organism to move through obstacles to fulfill motivations. It is essentially, this capacity that, in somatic-energetic terms is destroyed, temporarily, or more chronically, by overwhelming experience. It is thus understandable that the traumatized individual develops all kinds of incapacities in functioning, helplessness, and loss of self-esteem.
4. Again, in Therapeutics.
The issue of self-respect and the capacity of the therapist to respect the patient’s somatic-energetic being is central in the therapy of trauma spectrum syndromes. This principal is illustrated in the following. Scaer, for example, describes a simple, careful procedure by which the clinician can test the patient’s vulnerability and the presence of trauma symptoms. With the patient sitting, or standing, the clinician can check boundary sensitivity by placing himself in different positions and distances in relation to the patient (Scaer 2001, pp. 119-129). The patient’s reports of her experiences will sometimes reveal a sense of vulnerability or sensitivity at particular points, as if the boundary were torn at that point as if it had a history of being violated. This represents a respectful attunement to the somatic-energetic being of the patient and encourages the patient to adopt a similar attitude towards herself.
I am delineating by various intimations a therapeutic attitude. It is very difficult to describe or convey an attitude. In this regard, I appreciate the words of David Shapiro (Shapiro 1999), a psychologist known for his character analytic approach to psychotherapy.
[H]ow does one teach an attitude of respect for the patient, not merely courtesy and not sentimental concern, but respect for the patient’s psychology? How, for that matter, can one teach an interest in the patient, nor merely an interest in changing him, but an interest in him and communicating with him? … They can be developed only through a certain kind of understanding of the patient. Understanding can engender a therapeutic attitude. (Shapiro 1999, p.v)
As Shapiro implies here, a respectful attitude is different from a therapeutic intent to change the patient, however well intended. Shapiro mentions “interest” in the patient, “understanding,” and interest in “communicating” with the patient. This delineates a therapeutic stance. It is a therapeutic stance that is a way of being, being with, perceiving, and communicating in a respectful attitude. It is not a doing stance, not an activity in which the therapist does something in relation to the patient.
The attitude of respect depicted by Shapiro is entirely compatible with the attitude of respect that I am depicting. There is, however, a difference. The difference is that, while Shapiro is proposing a “respect for the patient’s psychology,” I am proposing a respect for the patient’s somatic-energetic being. How does one develop this form of respect? Shapiro indicates that respect for the patient’s psychology can be developed through “a certain kind of understanding of the patient,” and I believe this is true. Can one develop respect for the patient’s somatic-energetic being through a “certain kind of understanding of the patient?” Yes and no. The issue here is that the therapist can develop a respectful understanding of the patient’s somatic-energetic being only on the basis of his or her own development of self-respect. This requires specifically somatic-energetic experience of oneself which can be acquired only through the somatic-energetic exploration of one’s own character and traumas.
Eckberg’s work (Eckberg 2000) is a model for the development and acquisition of self-respect and a resulting capacity for the respectful therapeutic stance towards her patients’ somatic-energetic beings. In her book Eckberg tells the story of her own medical torture and sexual abuse trauma as an adolescent and how the devastating effects of those led her to years of therapeutic exploration, much of it through somatic-energetic therapies. Her descriptions of her work with her clients conveys that she has held a feelingful and deep sensibility of what happens to the body and soul as a result of the terrible things humans can inflict on one another.
Thus, with two patients who had survived political torture and were refugees in the United States, Eckberg was able to tell them that they did not have to talk about what had happened to them until they were ready. She was then able to engage them in bioenergetic “interventions always varied according to what was happening with the client at that time” (Eckberg 2000, p. 48).
[O]verall the emphasis was on helping the client to let down while exhaling, to sense the movement of energy down the body when doing this, to ease the movement of energy downward, to encourage elongation and expansiveness in the tissue, and facilitate parasympathetic activity. (Eckberg 2000, p. 48)
Eckberg comments that after a few sessions these clients began to believe she could help them, their symptoms began to improve, and they began to talk about what had happened to them. Eckberg is taking pains in this description to convey to the reader the therapeutic utility of somatic interventions. She conveys this and a great deal more.
In this quote Eckberg mentions several somatic-energetic processes: letting down, movement of energy downward, elongation and expansiveness in the tissue, and facilitating parasympathetic activity. These are somatic-energetic processes that can be perceived (by the therapist) and felt (by the client). However, they are very subtle subjective and behavioral phenomena, and to be attuned to them requires that the therapist be attuned to them in her own body. The therapist must also have the feeling for how and when to introduce somatic interventions to the patient which allow her to begin to experience, identify, and learn about these processes in her own body.
The gradual, titrated tracking of sensate, perceptual experience and the associated images, emotions, and thoughts allows for the reassociation of memory fragments. (Eckberg 2000, p. 51).
Earlier, I described the mirroring selfobject as the positive response to the aliveness of the baby or child. The respectful attitude, based on self-respect, embodies this function in therapy, in a manner precisely congruent with the mirroring selfobject. Eckberg explains this very succinctly.
Too much intensity is fundamental to the shock trauma experience. The life energy itself easily becomes associated (overcoupled) with anxiety and fear. Sensing one’s own aliveness, one’s vitality, is then experienced as threatening. Uncoupling (separating) the feeling of terror from the feeling of being intensely alive is an essential part of the treatment. (Eckberg 2000, p. 54)
In the vignette of Cindy’s therapy, we saw how she was dealing with this very issue, the fear of the feeling of her own aliveness. Cindy describes the attuned somatic interventions her therapist employed. These gently bring her back in touch again and again with her own body aliveness, allowing her to experience the aliveness without terror. This is a precise example of what Eckberg refers to (above) as the “Uncoupling (separating) the feeling of terror from the feeling of being intensely alive” (Eckberg 2000, p. 54). The respectful stance of the therapist makes this process possible, and the patient’s self-respect develops in conjunction with this process.
In conjunction with this core process in the treatment of trauma spectrum disorders, there is the secondary process described by Eckberg as a “gradual, titrated tracking of sensate, perceptual experience and the associated images, emotions, and thoughts allow[ing] for the reassociation of memory fragments” (Eckberg 2000, p. 51). This describes the treatment of dissociation in the context of somatic-energetic therapy and the development of narrative memory for traumatic events which were dissociated. The patient’s self-respect is also developed in the course of these therapeutic experiences.
6. Parallel to Therapeutic Work with Shame.
Morrison’s (1989, 1994) description of the therapy of shame parallels Eckberg’s description of the therapy of trauma as “a gradual titrated tracking of sensate, perceptual experience and the associated images, emotions, and thoughts” (Eckberg 2000, p. 51). Morrison (1989) describes a “protracted empathic immersion in the feeling state of any patient” that will “usually unveil deep and painful shame feelings,” and must also include the therapists’ “acknowledgment of their own shame” (Morrison 1989, p. 82). Both of these writers, each a pioneer in their field, describe an approach to treatment that involves the therapist in a fine grained “empathic immersion,” in Morrison’s felicitous phrase, in the experience of the patient.
This similarity in treatment approach makes sense in light of the view that shame vulnerability lies in the continuum of trauma spectrum disorders. It also makes sense in light of the conception that shame offers a converse reflection of self-respect. In shame, the self is viewed as deficient, flawed, and falling short of a grandiose ideal, resulting in the constant intrusion of painful self states or varying needs to defend against them. Treatment of this vulnerable condition requires the “gradual titrated tracking of sensate experience” and the immersion in the patient’s feeling state, in this way allowing for the establishment of self-respect.
Concluding Comments: Selfhood and Health
Self-respect is a way of experiencing the self. It can be considered a condition of the self. Finally, it can be considered as the condition or ground which determines the quality of other experiences of the person. A self experience implies the sense of having the subjective feeling of being one of my experiences. It carries the momentary, encompassing feeling of being “me,” can potentially be expressed in a sentence starting with ‘I’ followed by an expression of ownership such as indicated by the word ‘am.’
In the same way, shame, when it is experienced, is a self experience and carries the feeling of being “me” – all too much so. Similarly many posttraumatic conditions encompass selfhood, and carry the feeling of being me, or – famously, as in the case of dissociation – encompass a not-me. When people come to therapy it is usually because, in one way or another, they are having difficulty with their self experience, which is to say they are having difficulty with their experience. The supposition that another person could meet them and help them with these kinds of difficulties is natural and appealing. We look to others for help, when possible, and if we can allow ourselves. This seems natural enough given that these very experiences for the first many years of life for everyone are given a shape, quality, and meaning in the context of the facilitating environments of childhood, and these are mostly made up of caretaking relationships with the older generations.
Earlier, at different points in this essay, I pointed out where those facilitating environments are deficient, violating, and distorting. The selves that result from development within these environments are then deficient, violated, and distorted, making for enormous suffering which is passed on to the next generation and to partners.
How does an unhealthy self get healthy? I have suggested that therapeutic intervention can have as its basis and goal a kind of respect for the organismic, psychological, and spiritual being of another person. And I have suggested that this, attitude in conjunction with a knowledge of the somatic-energetic make up of the individual and skillful application of somatic-energetic interventions can facilitate the development of self-respect in the one who is the patient. Nothing, I believe, fosters the development of a healthy selfhood more than this core development of self-respect. It is through self-respect that negativity and destructiveness of all kinds towards the self can be neutralized.
In this process, the therapist is engaging with the patient in such a way as to lend a hand in helping the patient learn to manage his/her own self experience, the experiences that were unbearable to manage, experiences that the individual perhaps never even had even the opportunity to learn that they could be managed in a different way. This is usually a painstaking, fine-grained process for patient and therapist alike.
In the final stages of this process, if and when patient and therapist can reach such a stage, the patient is learning a new form of managing selfhood. At this stage, the patient, like every other human being, will probably have painful and very difficult experiences which still arise from inner resources. A final step in learning the management of selfhood is the learning to manage these difficult experiences, to see them for what they are, to not be distracted by them, but to still have enough self-respect to bear them without denial or dissociation, and even to give them the time and place they need for the somatic-energetic organization to process them and let them pass through and out of the system. One can learn still from these experiences at this stage of development. They show us who we have been, where we came from, and what made the world seem the way it has. They are human experiences, and they can show us how it is for most other people.
References
Aarts, P.G.H., op den Velde, W. 1996. “Prior Traumatization and the Process of Aging. Theory and Clinical Implications.” In van der Kolk, B.A., McFarlane, A.C.,& Weisaeth. L., eds., Traumatic Stress. The Effects of Overwhelming Experience on Mind, Body, and Society. NY: The Guildford Press.
Angyal, Andrus. 1965. Neurosis and Treatment: A Holistic Theory. Eds. E. Hanfmann and R.M.Jones. NY: John Wiley & Sons.
Blatt, Sydney. 2008. Polarities of Experience. Relatedness and Self-Definition in Personality Development, Psychopathology, and the Therapeutic Process. Washington, D.C.: American Psychological Association.
Buie, Dan. 2004. Five day didactic workshop. References based on author’s notes.
Eckberg, Maryanna. 2000. Victims of Cruelty. Somatic Psychotherapy in the Treatment of Posttraumatic Stress Disorder. Berkeley CA: North Atlantic Press.
Fallada, Hans. 1947/2009. Every Man Dies Alone. Tr. by Michael Hofman. Brooklyn, NY: Melville House Publishing.
Gilligan, Carol. 1982. In A Different Voice. Psychological Theory and Women’s Development. Cambridge, MA. Harvard U. Press.
Hayes, S.C. 2004. “Acceptance and Commitment Therapy and the New Behavioral Therapies: Mindfulness, Acceptance, and Relationship.” In Hayes, S.C., Follette, V.M., Linehan, M.M., eds. 2004. ¬Mindfulness and Acceptance. Expanding the Cognitive-Behavioral Tradition. NY: The Guilford Press.
Helfaer, Philip M. 1998/2006. Sex and Self-Respect. The Quest for Personal Fulfillment. Alachua, FL. Bioenergetics Press. (paperback ed.)
_____________. 2007. “Shame in the Light of Sex and Self-Respect,” Bioenergetic Analysis. Vol. 17. Pp. 57-79. Also in, Handbook: Bioenergetic Analysis.
Herman, J. 1997/1992. Trauma and Recovery. NY: Basic Books.
Meissner, W.W. (1997). “The Self and the Body: I. The Body Self and the Body Image “. Psychoanalysis and Contemporary Thought. Vo. 20. No.4. pp. 419-48.
Monson, C., M.J. Friedman, & H. A. LaBash. 2007. “A Psychological History of PTSD,” in Friedman, M.J., Keane, T.M., Resick, P.A. Eds. Handbook of PTSD. Science and Practice. NY: Guilford.
Morrison, A.P. 1987. “The Eye Turned Inward: Shame and the Self.” Ed. D.Nathanson, The Many Faces of Shame. NY: Guilford Press.
_____________. 1989. Shame, The Underside of Narcissism. Hillsdale, NJ: The Analytic Press.
___________¬¬¬¬¬¬¬¬¬¬¬¬¬¬ . 1994. "The Breadth and Boundaries of a Self-Psychological Immersion in Shame. A One-and-a-Half Person Perspective.” Psychoanalytic Dialogues. Vol.4 (1). Pp. 19-35.
______________. 1998/1996. The Culture of Shame. NY: Jason Aronson.
Neff, Kristin. 2011. Self-Compassion. NY: William Morrow.
Neria, Y., DiGrande,L., Adams. B.G. (2011). “Posttraumatic Stress Disorder Following September 11, 2001, Terrorist Attacks.” American Psychologist. Vol. 66, No.6, pp. 429-446.
Rizzuto, Anna-Maria, W.W.Meissner & Dan H. Buie. (2004). The Dynamics of Human Aggression: Theoretical Foundations, Clinical Applications. NY: Brunner-Routledge.
Scaer, Robert. 2001. The Body Bears the Burden. Trauma, Dissociation, and Disease. Binghamton, NY: The Haworth Medical Press.
___________. 2005. The Trauma Spectrum. Hidden Wounds and Human Resiliency. NY: W.W.Norton & Co.
Shapiro, David. 1999. Psychotherapy of Neurotic Character. NY: Basic Books.
Solomon, Z. 1993. Combat Stress Reaction. The Enduring Toll of War. NY: Plenum Press.
Stern, Jessica. 2010. Denial, A Memoir of Terror. NY: HarperCollins.

Rosen, Michael. 2008. The Quest for Authenticity: The Thought of Reb Simhah Bunim. Brooklyn, NY. Lambda Publishers, Inc.
van der Hart, O., E. Nijenhuis, & K. Steele. 2006. The Haunted Self. Structural Dissociation and the Treatment of Chronic Traumatization. NY: W.W. Norton.
White, Marjorie Taggart. 1980. “Self Relations, Object Relations and Pathological Narcissism.” The Psychoanalytic Review. Vol. 67. Pp. 3-23.