Showing Yourself Compassion in the Face of Shame and Guilt

For many people with obsessive-compulsive disorder (OCD), a harsh voice of self-criticism seems to follow every intrusive thought. It brings on waves of gut-wrenching guilt, makes them constantly question their character, and insists they need to “make up” for the thoughts they never chose to have. Sometimes, it even convinces them that this harsh inner dialogue is necessary—that it’s somehow keeping their worst fears at bay.

In reality, it often has the opposite effect, leaving them caught in an exhausting cycle: intrusive thoughts trigger shame, shame leads to self-punishment, and self-punishment keeps them trapped in OCD’s grip.

It’s a pattern that Kimberly Quinlan, LMFT, has seen countless times as a therapist specializing in OCD and related disorders, and one she believes can be transformed through self-compassion. In this excerpt from the Get to know OCD podcast, Kim explains how self-compassion challenges everything OCD wants you to believe about yourself, and how starting to practice it can help you stop fighting this internal war. You can watch Kim’s full interview on Get to know OCD here.

This interview has been edited for length and clarity.

Can you tell us about this idea of bringing self-compassion into therapy?

I was really lucky that self-compassion was naturally such a part of my eating disorder treatment. I don’t think I actually would have recovered if my therapist hadn’t also introduced it. As I was recovering, I was interning at an OCD center here in Los Angeles, and no one was really talking about self-compassion.

I did see, particularly with folks who had more taboo obsessions, that they were just beating themselves up, and it was getting in the way of recovery. They were not doing their exposures. They weren’t doing response prevention. They were just beating themselves up. So I asked my supervisor, “Can I bring this into the room?” He said, “Go for it,” and I started playing with these ideas. They ended up being a breakthrough for several of my clients in terms of, “We can get to the actual work now that you’re not beating yourself up.”

Self-compassion seems to be so important when the particular focus of the fear is around an identity-based thing, and OCD can really tear down someone’s identity. Those thoughts of “Am I a good person or a bad person?” or “If I don’t do this compulsion, bad things might happen,” can make them feel like their whole identity is on the line. I think self-compassion allows us to get to a place where there is a sense of kindness toward how much those disorders are aggressively attacking us.

How would you define self-compassion? And how do you try to teach it to people?

My definition of it has evolved over time, but I’m always specifically speaking to my highly anxious friends. And I talk about self-compassion more as the act of doing what is best for the future you. It’s an act of taking care of you.

I call it an “inner bestie.” It’s acting in a way where you’re honoring the long-term benefit and wellness of your own self. That can sometimes mean being very gentle and kind and nurturing. Sometimes, particularly for those of us who have mental struggles, it can also involve being fierce and taking care of things, and going to therapy, and facing your fears, and saying no to what OCD is trying to get you to do. These two opposing parts of self-compassion have to be included in order for it to work well for people with anxiety.

Another definition people have is that self-compassion is treating yourself the way you would treat a loved one in that exact situation. If you had an intrusive thought that you think is particularly horrendous, how would you treat someone if they came to you and said they had that thought? Chances are you wouldn’t call them a freak.

It’s also just being the wisest, most effective version of ourselves, which is usually focused on long-term benefits rather than short-term relief. The thing that benefits you in the long-term is often riding the waves of uncertainty and discomfort kindly and gently, and holding space for two opposing truths at the same time: This is hard and I’m going to face it, and I’m going to be gentle with myself.

There are people who fear that “If I’m nice to myself, or if I’m not beating myself up or putting myself down, then I’ll become the thing that I’m afraid of.” How do you work with that fear?

I did a poll about this with my podcast listeners, and almost a thousand people weighed in and said that one of the biggest roadblocks to self-compassion for people with OCD was “What if I snap and lose control because I’m not beating myself up?”

There was a whole other group who said, “This is how I motivate myself. I beat myself up and then I stop doing compulsions,” or “I beat myself up and then I get out of bed and I can actually face the day,” or “I beat myself up as a way to morally neutralize the bad thoughts that I’ve had.” There were many specific ways that people with OCD were using self-punishment as a compulsion, either to neutralize their obsessions or to “protect” themselves from losing control.

How I work with people who have that fear is, number one, I never insist that anyone stops beating themselves up. I want to give complete agency to someone—if that’s working for you, you get to continue it. But before you continue, can we just take a look at how it’s working, and is it actually working? When we slow down and we really inquire, we can also consult with some research, which says that beating yourself up and using self-punishment actually increases anxiety. And you don’t want that. Who wants more anxiety?

We also know based on the research that people who beat themselves up are significantly more likely to procrastinate over time than those who use self-compassion. So yes, it’s getting them to do the hard thing in the short term, but they end up procrastinating in the long term. We’re really there to inquire, is this working and could there be another alternative?

OCD likes to turn things on its side. Could there become a point where the goal to have self-compassion becomes a compulsion?

Not true self-compassion in my opinion. Self-compassion in its truest, purest form wants you to feel your feelings. Mindfulness, which is a huge component of self-compassion, is about being non-judgmental and allowing for all of the emotions to show up. And we treat these emotions gently as they rise and fall—even the really horrendous, horrible ones, even our OCD.

One of the biggest myths of self-compassion is that it’s letting yourself off the hook, because letting yourself off the hook can become a compulsion. You don’t have to be perfect, but self-compassion is not saying “It’s fine, let’s just do more compulsions.”

Self-compassion is also making space to be a little messy. And recovery for OCD is pretty messy in my experience. There are ups and downs. There are days that you do really well and days you don’t, but even if you’re not having a great day, you could be moving forward in your recovery by being gentle and not beating yourself up for that.

I’ve always said that the DSM got it wrong because it limited the definition of OCD to anxiety and distress and it didn’t talk about shame, guilt, disgust, and other experiences. What would you say OCD involves beyond the diagnostic manual definition?

My experience with OCD as a clinician has been that an obsession can be a thought, feeling, sensation, urge or image, so, yes, definition-wise OCD does involve things like shame and guilt. I’ve had clients whose whole obsession is guilt. They don’t have a lot of anxiety. They have guilt, guilt, guilt, guilt. And that’s why that self-compassion model is so important, because it gives them strategic, tactical skills to navigate these strong waves of emotion that can be very dysregulating.

There’s also shame, which can be one of the darkest emotions. It can take you into depression to where you don’t even get out of bed, so I think that we need to talk about it more. And I think that a lot of people will get help if they learn that OCD can target other emotions, too.

How do you personally practice self-compassion as someone who’s dealt with anxiety and an eating disorder?

Well, number one, I’m not perfect. I have a therapist that I see weekly. And I have therapists who are specialists in areas that I have struggled with in the past if I do need them. I’m not ashamed to say I’ll call an eating disorder specialist if I need one.

I am also very, very strict with myself—but in the kindest way—in the sense that I do not mess with my disorders. I know exactly how they show up. I know exactly how they trick me, and I’m very mindful in my day-to-day practice to help me catch it. If that thinking does come in, I’m very proud to say that I come to take it down. I have strict rules on how I’m allowed to treat myself, and those rules I was given by my clinicians have kept me in recovery for a long time.

What is your advice for people debating, “Should I go to therapy? Should I get help? Maybe I’m unhelpable,” or for those with a loved one who’s struggling? How do you get someone to take the first step?

First steps look different for everyone. First steps might be just making a call and telling somebody. First steps might be admitting yourself into an inpatient facility. It depends on where you’re at.

I think the most important piece here is, you can’t compare your first step to somebody else’s. A first step worth celebrating is anything that moves you towards your recovery. That might be looking at a NOCD article and becoming educated. It might be telling a friend. It might be admitting to yourself that you have the condition.

I also want to say “unhelpable” is not a real thing. We have a brain that is highly neuroplastic, which means it can change when we change our behaviors. And no brain is the exception to that rule. Tiny little changes make for medium-sized changes, which make for large changes, so it’s just about taking that first baby step and being as gentle with yourself as you can.

Watch Kim’s full interview on Get to know OCD

Finding your way to self-compassion isn’t something you have to figure out alone. Through exposure and response prevention (ERP) therapy, the most effective treatment for OCD, you can learn to manage the difficult thoughts and feelings of OCD without falling into self-blame. At NOCD, all of our therapists are extensively trained in ERP and have a deep understanding of how OCD can affect your entire sense of self. They can guide you through the process of learning to manage OCD, while encouraging you to show yourself the kindness you’ve always deserved.

Book a free 15-minute call with our team to learn more about getting matched with a NOCD Therapist and starting treatment that can help you reclaim your life.