Practitioner guide: Shame and stigma

Shame and stigma: A barrier to caring for each other and help-seeking 

Shame and stigma can show up in families in many ways that make life harder by:  

• disrupting connection
• creating isolation
• negatively impacting identity; and
• undermining the role that family members have in caring for each other.¹

The anticipation of stigma, and previous discriminatory service experiences, can create barriers to families seeking support^{2, 3, 4} and compound the harm of marginalisation. Children who have experienced trauma also report shame and the anticipation of stigma, leading to non-disclosure and avoidance of help seeking.⁵  

These fact sheets have been created by families who have experienced shame and stigma. It is their hope that the resources might be a helpful tool for practitioners to use in supporting other families to:  

• make sense of shame and stigma  
• reclaim their own marginalised knowledges and skills of surviving; and  
• spark some hope and new ideas for navigating these challenges.   

They also hope the resources will offer ideas to practitioners about:  

• how to stand against stigma  
• ways of supporting families that reduce rather than increase the harmful effects of shame; and 
• ensure that families have authorship over their own lives. 

Exploring obstacles

Instead of asking ‘What’s wrong in your family?’, practitioners can instead consider the question: ‘What’s getting in the way of living the way you might want to, and what might help?’ This different orientation shifts the focus to reposition the constraints (what’s getting in the way) as the issue, rather than the family. By using this approach, therapeutic work can become a collaboration between the practitioner and family to help family members identify and address the obstacles they are facing without anyone feeling a sense of blame or shame. Families can unite to problem-solve together, rather than being pitted against each other, because issues are no longer tied to their individual or family identities.^{6, 7}

It also makes more space for collaborative and creative explorations of responses to shame and stigma that families are already making or might make in the future.

Understanding structural barriers

Understanding structural barriers involves understanding the challenges facing the family by examining the context and circumstances around the family that are obstacles to them living differently. You may like to read further about structural competency, which calls for a new approach to the relationships among race, class, and problems faced by children and families.

How to use these resources

These resources and the following reflection questions have been created using an approach informed by collective narrative practice. The questions are designed to support you to use this resource in your work with families in ways that:

• explore what they already know, what skills they already have, and the values that inform their choices and actions
• are attentive to the structural barriers they are facing that make change and preferred ways of living less available
• expand what might be possible for them through connecting with the stories and ideas shared by other families; and
• reduce experiences of isolation, blame and shame.

We also invite you to always be vigilant and attentive to the often missed or invisible skills, knowledges, values and contributions that children have in their lives, families and communities.

You may also want to take a look at the Dulwich Centre’s Narrative justice and the (draft) charter of story-telling rights as a way to extend your thinking and enliven commitments to justice in therapeutic practice.

Reflective practice

We encourage you to think reflectively about your practice and propose asking the families you work with and yourself the following questions alongside these resources.

Reflection questions for working with families

• What stands out to you in this resource? Are there any particular words, phrases or stories? Why did these stand out compared to other parts of the resource?
• What stories from your life did it make you think of?
• What skills or responses reminded you of your family?
• Is there anything you didn’t like or had a strong reaction to?
• Is there anything you would like to explore in more detail?
• What would you add to this list of wisdom shared by other families? What are your ideas? (See if you can come up with opportunities for the families you work with to share their stories/knowledges with other families.)
• What might you do differently after reading the resource? What (if anything) might be more possible for you and/or your family?

Reflection questions for practitioners

• How might shame or stigma impact the ability of families to access your service and ask for the help they need?
• What did reading this resource prompt you to think about differently?
• In what way might your practice be shaped by the wisdom shared in this resource?
• What responsibilities do you have as a practitioner to not just respond to the suffering that families you support experience, but to change the unjust systems creating shame, stigma and suffering?
• How can your team or organisation support all families in your community in their efforts to respond to shame and stigma in the face of structural barriers or other adversities, and in ways that don’t create blame?
• If you found this resource useful, how might you share it with your team or organisation, or incorporate it into your practice?

Other shame and stigma resources:

Read more about how families are standing up to shame and stigma by:

More resources:

References

1. Anderson, K. (2021). Shame, blame and stigma towards families. Visions Journal, 17(1), 8–9.
2. Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013). Mental illness stigma, help seeking, and public health programs. American Journal of Public Health, 103(5), 777–780. DOI: 10.2105/AJPH.2012.301056.
3. Vogel, D. L., & Wade, N. G. (2009). Stigma and help-seeking. The Psychologist, 22(1), 20–23.
4. Pattyn, E., Verhaeghe, M., Sercu, C., & Bracke, P. (2014). Public stigma and self-stigma: Differential association with attitudes toward formal and informal help seeking. Psychiatric Services, 65(2), 232–238. DOI: 10.1176/appi.ps.201200561.
5. Schomerus, G., Schindler, S., Rechenberg, T., Gfesser, T., Grabe, H. J., Liebergesell, M., Sander, C., & Speerforck, S., (2021). Stigma as a barrier to addressing childhood trauma in conversation with trauma survivors: A study in the general population. PLoS One, 16(10), e0258782. DOI: 10.1371/journal.pone.0258782.
6. Madsen, W. (2007). Collaborative therapy with multi-stressed families (2nd ed.). Guilford.
7. Madsen, W., & Gillespie, K. (2014). Collaborative helping: A strengths framework for home-based services. Wiley.