Reducing Shame in Care: Trauma, Addiction, and Meeting People Where They Are
One of the things I find myself coming back to again and again, both in therapy and in my continuing education, is the role shame plays in keeping people stuck. (This is likely because I am familiar with my own relationship to shame)
Whether someone is struggling with substance use, disordered eating, ADHD, chronic stress, or the long-term effects of trauma, shame is often quietly sitting underneath the surface. It doesn't usually sound dramatic. Instead, it tends to sound familiar.
"Why can't I just get it together?"
"Everyone else seems able to do this."
"What's wrong with me?"
Unfortunately, those aren't just messages people tell themselves. They're messages that many people have heard from family members, schools, workplaces, healthcare systems, and sometimes even previous therapists. Over time, those experiences can become internalized until it feels like the problem isn't simply the behavior. It feels like you are the problem.
Instead of asking, "Why won't this person change?" I want to encourage us to ask, "What makes sense about this behavior?"
That shift changes almost everything.
Looking Beyond the Behavior
Traditional medical models have often focused on eliminating symptoms or stopping behaviors. There are certainly times when symptom reduction is important, but that behavior rarely exists in isolation.
When someone is using substances, restricting food, binge eating, procrastinating, avoiding difficult conversations, or struggling to complete everyday tasks, there's usually a reason those behaviors developed in the first place.
Instead of immediately asking,
"How do we stop this?"
a trauma-informed lens invites us to become curious.
What is this behavior helping this person survive?
What need is it meeting?
What would make change feel safe enough to become possible?
I think that's a fundamentally different starting place. It doesn't excuse harmful behaviors or suggest they don't need to change. Instead, it recognizes that sustainable change is much more likely when people understand why they developed a coping strategy before they're asked to let it go. I've found that when people feel understood instead of judged, they're often much more willing to talk honestly about what's happening. And honesty is where meaningful therapy begins.
Continuing Education That Strengthened This Perspective
Over the past several years I've intentionally sought out trainings that deepen my understanding of trauma, addiction, neurobiology, and compassionate care. I will continue to do so and this blog post is (Mostly for SEO) a way of me putting down some of what I have done.
Those include:
S.A.V.E. Suicidal Thoughts(Completed 2026)
Defeating Habits and Addictions(Completed 2026)
Do I Need to Be an Addictions Expert? Engaging and Supporting People Who Use Drugs(Completed 2023)
Working with People Who Use Drugs: Understanding Stigma(Completed 2023)
Intersections Between Trauma and Addiction(Completed 2023)
Eating Disorders: What to Say (or Not) and Getting Your Client Proper Help(Completed 2023)
Brief Interventions in Primary Care(Completed February 22, 2023)
Again and again, the message was that people don't avoid care because they don't want help. More often, they avoid care because they expect to be judged. The trainings consistently emphasized the importance of reducing stigma, using nonjudgmental language, respecting autonomy, building trust before pushing for change, and understanding coping behaviors within the broader context of someone's life rather than viewing them as evidence of a personal failing.
That philosophy feels deeply aligned with how I already wanted to practice. These courses gave me more language, more research, and more confidence in following that path.
Trauma, Addiction, and the Nervous System
I want to speak a little bit to the relationship between trauma and addiction. It's something that has been written about for years, but I always feel like when ever I hear the same approach from a different person I learn something new.
When we think about addiction through a moral lens, it's easy to ask questions like, "Why would someone keep doing something that's hurting them?" But when we begin looking through the lens of trauma and nervous system regulation, a different question starts to emerge.
What was this behavior helping them survive?
For many people, substances aren't simply about pleasure. They can temporarily quiet intrusive memories, soften anxiety, numb emotional pain, reduce hypervigilance, or create moments of relief when life otherwise feels unbearable. That doesn't mean substance use is harmless, nor does it mean recovery isn't important. It simply means that before we ask someone to let go of a coping strategy, it's worth understanding what that strategy has been doing for them.
That shift feels important to me because it preserves dignity. Rather than assuming someone lacks motivation or willpower, it recognizes that their nervous system has been trying, sometimes desperately, to find relief. I've found that when we approach people with that kind of curiosity, conversations often become more honest. People are much more willing to talk about the parts of themselves they've been hiding when they don't feel like they're going to be judged for having those parts in the first place.
Eating Disorders and Addiction: Similar Roots, Different Paths
One section of these trainings focused specifically on eating disorders, and I appreciated that it approached them with many of the same principles used in trauma-informed addiction work.
Although eating disorders and substance use can look very different on the surface, I found myself thinking about how often they seem to grow from similar roots. Both can become ways of regulating overwhelming emotions, managing shame, creating a sense of control, or surviving experiences that otherwise felt impossible to carry. Both often involve cycles where a behavior brings temporary relief while also creating longer-term suffering. And both are deeply shaped by stigma.
One difference that stood out to me is how differently society responds to them.
Substance use is often quickly recognized as an addiction, even if it's heavily judged. Disordered eating, on the other hand, can sometimes be praised or overlooked, particularly in a culture that frequently rewards restriction, weight loss, and self-control. Diet culture has a way of disguising suffering as discipline, which can make eating disorders harder to recognize and delay people from receiving support.
Food also presents a unique challenge because recovery isn't about abstinence. Unlike substances, we can't simply remove food from our lives. Recovery asks us to rebuild a relationship with something we need every single day. That makes compassion, flexibility, and nervous system regulation especially important.
Reading and learning about both topics together reinforced something I've come to believe more broadly. Behaviors rarely tell the whole story. Whether someone is drinking, restricting food, binge eating, overworking, avoiding difficult conversations, or endlessly scrolling their phone, I'm often less interested in the behavior itself than I am in the need it's trying to meet.
The Importance of Language
Another theme that appeared throughout these trainings was something that might seem small at first but feels incredibly significant in practice: the language we use. I have a running joke with my friends and family when ever I have a malapropism pop into my language, something that happens often. I will tease myself and say “AND I TALK for a living!?” Which is mostly a joke but also there is a little truth in that moment. I do worry that I use the right language, I do try to be careful and kind AND I am sure I make mistakes.
Changing our language can be as simple as shifting how we talk about issues. Instead of describing someone as "noncompliant," we might become curious about what barriers they're facing. Instead of labeling someone as "resistant," we might wonder whether they're protecting themselves based on experiences they've had in the past. Rather than reducing someone to "an addict" or "an alcoholic," we can remember that they're a person who happens to be living with a substance use disorder.
The same is true when talking about eating disorders, bodies, and food. Even well-intentioned comments about weight, health, or willpower can unintentionally reinforce shame. These trainings encouraged clinicians to use language that stays neutral, collaborative, and respectful while recognizing that many body-based struggles are deeply connected to trauma, control, identity, and safety.
That emphasis resonated with me because it reflects something I try to practice throughout my work. Language matters. The words we choose can either reinforce shame or create enough safety for someone to tell us what they're really experiencing. Sometimes that shift is subtle. But subtle doesn't mean insignificant.
How Neurodiversity Shapes the Way I Think About Shame
One of the reasons this topic feels so important to me is because I don't come to it only as a therapist. I also come to it as someone with ADHD and dyslexia.
Like many neurodivergent people, I grew up hearing messages that probably sound familiar to a lot of others.
"You just need to try harder."
"If you cared, you'd remember."
"Why is this so difficult for you?"
Those messages have a way of settling into us over time. They become less about a missed deadline or forgotten appointment and more about how we begin to understand ourselves. It's easy to start believing that struggling means you're failing, rather than recognizing that your brain may simply work differently.
While ADHD isn't the same as addiction or trauma, I do think there are important parallels. So many people, regardless of the challenges they're facing, have spent years feeling misunderstood. They've been told their behavior is the problem without anyone stopping to ask what might be happening underneath it.
That experience has made me especially sensitive to the ways shame can quietly become part of someone's identity. When I sit with clients who are navigating addiction, eating disorders, trauma, or executive functioning challenges, I don't immediately see a lack of motivation or willpower. I find myself wondering what their nervous system has learned. I wonder what they've had to adapt to. I wonder what has helped them survive, even if those strategies are no longer serving them today. That doesn't mean every behavior is healthy or that change isn't important. Of course it is. But I think lasting change is much more likely when people feel understood instead of judged.
Meeting People Where They Are
"Meeting people where they are" is a phrase that's used often in healthcare, but I've found myself thinking more deeply about what it actually means. To me, it isn't lowering expectations or avoiding difficult conversations. It's recognizing that people can only take the next step from where they're currently standing. Growth will always look different on each person.
Sometimes that means slowing down instead of pushing harder. Sometimes it means helping someone understand their coping strategies before asking them to replace them. Sometimes it means acknowledging that motivation and capacity aren't always the same thing. A person can desperately want things to be different while still not having the internal or external resources to make change happen yet. It also means recognizing that people don't have to earn compassion by getting better first.
Support isn't something we offer once someone has figured everything out. It's often the thing that makes change possible in the first place.
What I Keep Coming Back To
Looking back over these trainings, it's interesting that they covered topics that seem quite different on the surface. Substance use, eating disorders, suicide prevention, primary care, trauma, stigma, and harm reduction aren't usually grouped together.
But the more I reflected on them, the more they seemed to be asking the same question.
How do we create conditions where people feel safe enough to heal?
Again and again, the answer wasn't more judgment or more pressure. It was reducing shame. It was building trust. It was recognizing the wisdom behind behaviors before trying to change them. It was respecting autonomy while offering support. It was remembering that every behavior, even the ones that worry us, developed for a reason.
That doesn't mean those behaviors always continue to serve us. Part of therapy is helping people discover new ways of meeting those same needs. But I think there's something profoundly healing about beginning with compassion instead of correction.
That's the thread I keep coming back to.
Not because compassion is "nice."
Because, in my experience (and the science says so too!) , it's one of the most effective ways to help people create lasting change.
A Personal Reflection
One of the things I love most about being a therapist is that I rarely get to simplify people. I get to see and know humans in a deeply complex way. I know that every person I work with has a story that's more complicated than whatever brought them to therapy that day. They're carrying relationships, histories, identities, strengths, losses, hopes, fears, and countless experiences that have shaped how they move through the world.
I don't think my job is to tell someone who they should become. It's to understand who they already are.
Sometimes that means helping someone untangle years of shame. Sometimes it means making sense of behaviors that no longer fit the life they want. Sometimes it simply means sitting with another human being long enough that they no longer feel like they have to carry everything alone.
Digging Deeper
If this post resonated with you, you might also enjoy exploring:
ADHD & Mindfulness – Why traditional mindfulness doesn't always work for neurodivergent brains, and how a more flexible, compassionate approach can.
Culture, Power & Belonging – Looking at therapy through a systems lens and understanding how identity, community, and social structures shape mental health.
Trauma Therapy – Exploring how trauma affects the nervous system and how healing can happen without shame.
Mindfulness – A broader look at mindfulness as awareness rather than perfection, and how it supports emotional regulation.
Internal Family Systems (IFS) – Understanding protective parts with curiosity instead of criticism.
Narrative Therapy – Exploring how the stories we inherit influence how we see ourselves, and how those stories can be rewritten.
Identity Work – Making space for the parts of yourself that may have been hidden, protected, or misunderstood.
Anxiety & Panic – Understanding anxiety through the lens of the nervous system rather than personal failure.
Contact Me – If these ideas resonate with you and you'd like to explore them together, I'd be happy to connect.