Intro 00:00
Welcome to the Practice Impossible Podcast where your host, Jude A., Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission, should you choose to accept, is to listen and be transformed. Now, here's your host, Coach JPMD.
Coach JPMD 00:24
Welcome to the Practice Impossible podcast with your host Coach JPMD. So before we continue on with our next guest, I'd like to have you pause this episode right now, and scroll down to the bottom of the screen. And leave a quick review. This will help in getting our podcast noticed by those who really need to hear it. Alright, thank you for that. Thank you for your support. So today's episode 11 is with Dr. Richard Shaw. So today's topic is a little bit heavier than than most topics that I've been discussing over the past couple of months. As we enter or as we're in September, September is National Suicide Prevention Month. And tomorrow is actually world Suicide Prevention Day. That's September 10. And this is dear to my heart because of the research I've done around suicide and physicians and healthcare workers. It is estimated that physicians end their lives 1.8 times more than the general population. This has been dear to my mission at Coach JPMD and and the work that we've been doing through the Practice Impossible Podcast, how can we as physicians care for others, if we're struggling ourselves?
I encourage you, if you're hurting, please reach out to a friend, a colleague, a mentor, for help. I know that Dr. Pamela Wibel has been doing a lot of work around burnout and suicide prevention. She actually has her own suicide prevention line that she communicates with physicians regularly. And you can find her at https://Idealmedicalcare.org/contact if you are struggling with any thoughts. Also, you can contact the National Suicide Prevention hotline at 1-800-273-8255 or 800- 273-TALK. And there someone can help you and get you the resources that you need. And of course now there's Dr. Richard Shaw. And he has written a book that describes the framework for healing shame through grace physicians and other health care providers are facing an overwhelming amount of stress. And that stress is compounded by the shame that they may be feeling with whatever they're going through. I know that there's at least one person that will find healing from the conversation that we're going to have with Dr. Richard Shaw. So I invite you to listen in on this conversation and do share it with anyone that you might know would benefit. So here we go. Hello, Dr. Richard Shaw, thank you for coming on to the Practice Impossible Podcasts. And we're so happy to have you and congrats on your new book! Shame no more - A framework for Healing Through Grace. Must be pretty exciting huh?
Dr. Richard Shaw, DMFT, LMFT, LHMC 03:01
Very much so. Thank you so much for having me.
Coach JPMD 03:04
So tell us about yourself. Tell us how you came to write this book and kind of what your journey was.
Dr. Richard Shaw, DMFT, LMFT, LHMC 03:10
So I'm from small town, Nebraska, I mean, small town population of 160 people. And I was a preacher's kid and a farmer's kid. And those things didn't always fit so well for me. And so education made a lot of sense to me. So I kind of went to school and just kept going to school. And I enjoyed that a lot along the way. I did some psychology work, some sociology works, professional counseling work, theology, some Marriage and Family Therapy. And by the time I was done, I think they were ready to kick me out because I've been there a long time and ended up with a couple of masters and a doctorate in the field. And, and this topic of shame has always been really important to me, it was a personal thing before it became a professional thing. I came from a good family, but not a great, perfect family. There isn't any perfect families out there. And so as I worked through some of my own stuff and tried to make sense of this thing, that now people talk about is shame. The language made so much sense to me. And I found myself just spending a lot of time reading, making sense of it the best I could for myself and then making application to other people around me professionals and anybody who would listen. So that has landed me in a professor position now for over 25 years training, a master's level professional counselors and Marriage and Family Therapist full time, my own practice as well.
Coach JPMD 04:39
So this is all in Nebraska or did you move from Nebraska and...
Dr. Richard Shaw, DMFT, LMFT, LHMC 04:42
so started in small town Nebraska, ended up going to Asbury Seminary in Kentucky. And then from there went to Fuller Seminary in Pasadena, California. That was a little bit of a challenge from Kentucky to California.
Coach JPMD 04:57
You think?
Dr. Richard Shaw, DMFT, LMFT, LHMC
And then George Fox University actually brought me up as a professor 27 years ago, and I pretty much done all my professional work now in the Northwest. I'm in the Portland metro area.
Coach JPMD 05:09
Okay. So you gave me a story, or you told me a story about from thesis to book and he said something about, it took you 25 years to actually write this book, but it came in 2020. So he's saying, you know, I actually ordered the book, and it's on its way from Amazon. But I think I saw 231 pages. And so I calculated you wrote nine pages a year or something like that?
Dr. Richard Shaw, DMFT, LMFT, LHMC 05:37
That's funny, I love it. So the story really is, is that when I got to grad school in the late 80s, I took a course on professional counseling. And I got introduced really, for the first time to the language of shame and grace. And it was the first time that the language made sense for some of my experiences, my challenges. And so that started me on a journey. And so while I was in grad school, I just used every opportunity I could to read and to research and write about the topics. And then in the 90s, I wrote my doctoral dissertation on the concepts of shame, and grace, it turned into a course that I was going to travel with a little bit and speak, and then that I use at my current University. So it turned into a two day course. And I thought I would offer it a few times, and it would go away. In my world dissertations usually mean, you know, more and more and more about less and less and less. And at the end of that process, they go into a library, and they collect dust. Nobody ever really looks at them or reads them. And that didn't happen. I offered this as a weekend course. And people really responded to the material. And so it became a staple in our program. And now I've taught it for over 25 years, and knew that from that doctoral dissertation that I completed in the late 90s, at some point, it needed to get into another format, it needed to be a book. The truth is, I'm not a good writer, it's hard for me to do that I would rather talk to you all day long, or stand in front of an audience and talk then sit in my office and try to write it's just not a gift that I have. And so after teaching this for over 25 years, refining it working through in many ways in the last year or two, it really came to a point where it was time to put it into this format. And so with some help from other people that were just really, really key, we were able to take the steps forward and get it published and get it out there to the public. And I just am humbled and happy, I couldn't be more more content about what we have. That's wonderful.
Coach JPMD 07:55
And you know, one of the reasons why you're here also is because shame has come up in several episodes of our podcasts. One of the ones I recall is Episode Seven with Dr. Dennery. And just, you know, reviewing what physicians go through in their training. And here, we throw this word shame out all the time, but knew I had to kind of sit down and take a step back and say, okay, what's the definition of shame? So if you look at Merriam Webster, it's a painful emotion caused by consciousness of guilt, shortcoming, or impropriety. And I look at it as being such a negative thing. And but we use it often. And we, we sometimes use it to get people to do something that we want them to do, and threaten them with shame or, you know, it's it becomes a tool. Even sometimes in residency, I remember going through my rotations as a medical student third year, and starting the surgical rotation. One of our interns said, Hey, you know, what, if you're not sicker than the sickest patient in the ICU, then you need to be here at five o'clock in the morning. And I'm looking around, I'm like, Whoa, these are some sick patients. There's no way I will ever be sick. So I'll come to work sick. And you know, and that's just not, in retrospect, that is just a horrible thing to tell someone. Because then we think that becomes a norm as a third year medical student, then we go the fourth year, then we do residency. So, you know, how do you deal with that? How do you help others overcome that?
Dr. Richard Shaw, DMFT, LMFT, LHMC 09:27
So let's start with your definition there. And lots of authors have written lots of definitions on shame and grace. And I'll tell you, my personal, my definition of shame is "never enough". Never enough. It's never enough. You're never a good enough doctor. You're never a good enough husband or wife. You're never a good enough son or daughter. You're never good enough at whatever it is that you long and strive to do to make a difference in some way. And so that shame pushes you to try to do more and more and more and more, but it's like a ladder, that always has more rungs on it that you never get to the top of. So shame is about never being enough, never good enough. And grace, by the way, is enough. It's being enough. I tell my students in class that shame and grace are constructs. Shame is a construct for brokenness. And Grace is a construct for healing. So that's how I think about those terms. And you said it, shame works, it works. But the consequences that come with it are devastating. Shame and fear will motivate us to climb that ladder to be better and better and better show up at 5am or 4am, or the night before, or whatever. But the consequences that come with shame, are so devastating the fear that comes with that the internal struggles, that I can never get to this place that I strive to get to to be enough. One author calls it a shame attendant. It's like we have Gremlins or a shame attendant that's always there, that we can never quite escape that voice inside of us. That continually tells us it's never enough. It is so powerful.
Coach JPMD 11:41
Yeah. And I think it goes hand in hand with perfection. Perfectionism.
Dr. Richard Shaw, DMFT, LMFT, LHMC 11:44
It does, it does.
Coach JPMD 11:46
Because we are taught to be perfect. We are taught that as physicians, we need to know everything. And it took me a while to get come to the point where a patient will ask me something. And I said, I don't know.
Dr. Richard Shaw, DMFT, LMFT, LHMC 11:56
Right?
Coach JPMD 11:56
And so, but we're not necessarily taught that. So what would what would you say is the worst outcome of shame, in someone's personal life?
Dr. Richard Shaw, DMFT, LMFT, LHMC 12:07
So like you said that perfectionism drives shame in us that somehow we have to be above reproach, we have to be perfect. I can only imagine what that must be like, as a medical doctor or a surgeon to be able to be in that space where there's no room for error, there's no room for less than perfection. And the drive of that just is relentless. The truth is, there's all kinds of consequences that come a life of shame. The worst being that someone decides they can't do it anymore. It's just not worth it. And literally, they take their own life. Before that, it's the things that you probably would expect. It causes anxiety, it causes depression, it causes relationship issues with our significant others, in our parenting with our kids, in our workplaces, whether we're the boss or working for someone else, this thing just drives us and I love what you said, I do the same thing. It took me a long time in my classroom, to say to students, I don't know. Right? After 25 years in the profession, I'm supposed to be an expert in this field with this material. They expect me to know the answers. I expect me to know the answers. And so when they ask me something, and I invite them to ask questions, and I say when I say to you, what a great question that is, I don't know, let's explore let's sort this out. Let's figure it out together. You are literally helping me work on my own shame.
Coach JPMD 13:57
Interesting. So so it kind of leads into the that my next question is what does... What does it look like for someone that has no shame? Or I don't know if they can say no to shame or quote unquote, no shame?
Dr. Richard Shaw, DMFT, LMFT, LHMC 14:09
Yeah, so interesting question because there's, I'm going to answer that in two ways in a, in an not healthy way. A person with no shame, we might call it narcissist, or we might call a sociopath. In other words, they don't allow other people's opinions to impact them at all. Now, that's a negative no shame. I don't allow anything to impact who I am. I don't care what you say or what you think you have no influence on me. By the way. Side note, the opposite of that, sometimes we call a codependent. That's a person who cares too much what everybody else thinks about them. They want to make the world happy and they're willing to go to extreme levels In order to try to do that, so both ends of that spectrum, kind of the no shame and all shame often is tied into a place of how we relate to other people. But no shame in a healthy way healthy relationships, and not letting shame or that shame attendant or those Gremlins be they're always, always pushing at our door looks like good boundaries looks like being able to say no looks like being able to deal with consequences that come with the actions that we take. Having a healthy understanding of shame and grace allows us to make choices and live with consequences.
Coach JPMD 15:52
Yeah, that's really powerful. So your book is titled Shame no more - A Framework for Healing Through Grace. So what is that framework? Do you have like a stepwise process? And the book that did come out last week? I think or... July 26? Or...
Dr. Richard Shaw, DMFT, LMFT, LHMC 16:09 That's right. Absolutely. Yeah. Thank you, thank you.
Coach JPMD 16:11
So, can you give us a kind of a snippet? Like a quick overview as to what that framework looks like?
Dr. Richard Shaw, DMFT, LMFT, LHMC 16:17
So the idea of shame in a person, I say this in the classroom shame would be bad enough, if it just stayed in the person just inside of me. And I had to wrestle with my own personal shame. But the jump in shame that even makes it more powerful, is that there's a systemic piece to it, it shows up again, with my wife, with my kids at work, in the marketplace, in the world, in church, in business, and hospitals. And so shame is inside of me, but then it gets touched and triggered and impacted by all my key relationships. So we call that a systemic piece of shame. So it's more than just my own individual shame. And so really, the process of trying to work through that, in healthy ways, looks a little bit like this. Number one, I try to help people speak the truth out loud. Speak the truth out loud. When I'm getting tripped or triggered. When I'm struggling with my shame. I try to help people grab those moments when that's happening, slow it down, and speak truths about themselves about the circumstance about others about the relationship in that moment.
And I hesitate to say too much on this because I know honestly, you will know way more about this than I but as I understand it, literally what's happening in that process is we are helping people move moments that light up in our brains, from the reptilian area to the prefrontal cortex, where they have choices of what to do and what to say, and how to move forward. When moments are trapped in our reptilian brain. We basically have fight or flight as our moves. And so number one, we're capturing moments, we're slowing it down, we're moving in our brains where this moment lights up. And part of that process is helping people speak truth out loud. And then just really quick. Second, it's small changes, small changes over and over, and over and over. We know how change happens. That's how change happens. It happens a little bit at a time, over and over and over and over. And then third, we just try to help people practice that in the real world.
Coach JPMD 18:58
That's, that's really, really good. And does that make sense? It does make sense to me. And it speaks to the Pareto Principle, doing that one thing that you can do to help trigger that brain connection, and also as to do it repetitively over time to build a habit. And that's really great. And so you mentioned grace in the title. So how does grace come into play with that, and what is Grace?
Dr. Richard Shaw, DMFT, LMFT, LHMC 19:25
So again, for me, when I define shame, as never good enough, or never enough, then Grace is at least enough, if not more than enough Grace is this idea, this construct of healing of breakthrough of knowing that, I'm enough. It doesn't mean I'm perfect. It doesn't mean I'm not in process. It doesn't mean I'm not on a journey. But I'm enough, in the relationship enough in the moment and enough in relationship to God and others that he is a part of that journey in that process in that healing place. And so it's helping people speak the truth about their enough-ness. Even when they struggle, even when they're working on it, the recovery idea is kind of a day to day process, right? One day at a time. And the grace idea is not unlike that, where we are working on who we are, and the changes we're making on a day to day basis, knowing that I've got a chance and a chance and a chance and a chance to be able to make changes in my key relationships. And I'm an ordained minister as well, I believe that this starts in my relationship to something bigger and greater than who I am.
Coach JPMD 20:49
Absolutely.
Dr. Richard Shaw, DMFT, LMFT, LHMC 20:50
For me, that's God, that's Jesus Christ, and I find my grace in relationship to Jesus. And then I'm challenged to live that out, in my key relationships with my brothers and sisters in the world.
Coach JPMD 21:07
And from a practical standpoint, I mean, I can see exactly the things that you're talking about in that framework. And in the decisions I've made financially, you know, I've went through some short sales and stained my credit, had to list out on every application that I was applying for mortgages and credit. Some physicians have gone through lawsuits, and then they have to report that. So what you're describing is that antidote and that way of understanding that, yeah, we are enough, and these things will pass. And you're right, they have passed through better decisions, moving forward through, you know, getting the steps in place for me to get out of debt, to be able to be in a powerful position financially. But the same is true for for other decisions as well. That's, that's really, really powerful stuff.
Dr. Richard Shaw, DMFT, LMFT, LHMC 21:55
Thank you. The power of shame is in its silence, when when I feel like I can't share this with another I can't be authentic and honest and vulnerable with others, they'll never understand me, they'll never accept me though. They're going to affirm that I'm not enough. That's kind of the that element of greatest fear is if I come face to face with my own personal shame, and I decided to let somebody else into part of that world, they're going to affirm everything that I'm so afraid of inside of myself. And the truth is, over and over and over, when I've stepped into that space of vulnerability with others and authenticity, you know, what happens? People meet you there, and they tell you your story. And all of a sudden, we're like comparing stories of how we struggle in that place of hiddenness inside, and we break through in a way that allows me to share that connect with another and affirm each other, and we walk away closer than if we had to state on our own individual and keeping that stuff on the inside. Shame, thrives in hiddenness. It thrives in darkness, it thrives in silence, we have to break through that and make it more okay for people to sit around a table together and have real, hard, authentic conversations about ourselves. And what we're going to find often is most of the people at that table, not only relate to what they may have had very similar experiences.
Coach JPMD 23:39
Yeah, absolutely. Right. And that's happened to me multiple multiple times. So, you know, I like to ask this question in most of my podcasts, but I think you've answered it already. And if it's not one thing, it's multiple things, but what's the one thing you could tell a physician that they could do such that by doing it would help them overcome their shame? And I think you described that one thing, but what's, what's that one first thing?
Dr. Richard Shaw, DMFT, LMFT, LHMC 24:02
The heart of that is to speak the truth out loud with another. If every one of us could find someone that we felt safe with, that we trust, that we're willing to kind of go to the wall with and bare our souls, including the stuff we don't tell most people and have that person that we're able to say I'm going to speak some of these truths and some of these hurts out loud, and receive some of the care and feedback and connection that happens with you. And then you tell me your story, which is probably what's going to happen there. I mean, first week, bring those shame places out of the hiddenness and we put them in the light, and they just don't survive there. And then the second part of that is, is now we're connecting in real ways, with another surgeon, another human being who is also not perfect and trying to make sense of their own life in the world. And that connection that happens when we choose to step into that space. I'm not overdramatizing this, it will change your life.
Coach JPMD 25:20
So, so, so happy that I had you on the podcast today? And where can we find you? I know that you have the book coming out, it's on Amazon. And I'll link that in the show notes. Is there a website? Or is this somewhere we can find you online?
Dr. Richard Shaw, DMFT, LMFT, LHMC 25:34
So shamenomore.com is the best place to find me shamenomore.com. It is not a fancy website. It's very simple. But that's the best place to find me. I'm in the Pacific Northwest in the Portland, Oregon area. I practice here. I'm a full time Professor at George Fox University here. And that's the best place to find me. And to get more information about this along with finding shame, no more on amazon.com. You know, it's funny, when I first set up, I set up shame no more. Oh my gosh, again, it's more than 25 years ago, I was sitting in my house in a bonus room on a simple computer trying to do this. And I wanted no more shame. That was what was in my mind. But the website was gone. I couldn't get it. I couldn't trade market. And so I'm sitting there and I decided to turn it on a tear and come up with shame, no more learning to live with shame, no more. Nobody had the website, I could trade market, I grabbed it. And now like I said almost 30 years later, unbelievable to be able to work and walk in that freedom, the best I can and helping others to do the very same thing out of that shame
Coach JPMD 26:50
Congratulations. Congratulations on your book. And you know, I know that this will be successful because I know that there's a lot of physicians that would want to hear the framework and how they can overcome their shame. And it is possible I know through my own personal story. And you've described that in your personal stories as well. So thank you again, and may God continue to bless you.
Dr. Richard Shaw, DMFT, LMFT, LHMC 27:11
My pleasure. Thank you.
Coach JPMD 27:15
I'm so excited for the opportunity to have interviewed Dr. Richard Shaw and discuss his book Shame, No More - A framework for Healing through Grace. And it's my hope that physicians and other health care providers will find peace in knowing that there is someone that cares for them out there. Know that my personal healing came only from sharing my feelings and my experiences and, and things that I went through over the past several years, not only as a physician, but as a human being, especially sharing those things with people that I trusted. So take a look at the show notes for links to Dr. Shaw's book, and know that you are loved out there. You will be able to find the links and phone numbers to other resources as well. And I hope that this podcast episode enables you to understand why we don't need to be ashamed of the things that we do or things that we've gone through. Thank you so much for listening. And don't forget to leave a review and share this episode and other episodes with your friends and colleagues.
