At the Root of Binge Behaviors: Examining Shame in Impulse Control Disorders

Professional Q&A Q&A with Amy Tatsumi, MA, LPC, ATR-BC

At the Root of Binge Behaviors: Examining Shame in Impulse Control Disorders


Amy TatsumiAmy Tatsumi, MA, LPC, ATR-BC,  is a licensed professional counselor, psychotherapist, and board certified art therapist working with people of all ages in Washington, DC.  Amy received her Masters of Arts in Art Therapy from the George Washington University.

Within Amy’s private practice she specializes in working with women who are depressed, anxious, in transition, or feel stuck.  Clients learn strategies to decrease and manage feelings of depression, anxiety, and stress.   She helps clients to deal with old patterns and habits so that they can see themselves and others from a new light, live a more balanced life, and deepen connections.  

Amy’s style is supportive, collaborative, and holistic with a touch of humor.  She also sees therapists for therapy and offers post graduate and post license supervision.  In 2012, Amy started the Connections Certification process and provides a variety of offerings related to Dr. Brene Brown’s work.  The offerings are especially supportive for adults and teenagers who feel stuck, unworthy, and not good enough and for those who struggle with perfectionism.


Your practice specializes in helping women who struggle with depression, anxiety, and who are in transition or who feel stuck.  It must be very rewarding to see clients begin to accept themselves without clinging to an unrealistic ideal of what a woman “should” be.

As that unrealistic ideal relates to body image and binge eating, how do you begin the process of identifying what a healthy ideal is vs. an unhealthy ideal?

The number one area of shame for women is in appearance.

Most women experience a double bind in some part of their appearance (e.g., weight, body, hair texture, face, and/or style).  An example of double bind can be seen in the saying “There is nothing sexier on a woman than confidence”, however our culture perpetuates an ideal body image for woman which only focuses on the physical.

Developing critical awareness is the foundation of understanding where the ideal and unhealthy body images originate and why they are so powerful.  Why they hold so much sway within our society, media, places of work, communities, families, and relationships.

Clients start by examining and understanding where the ideals come from and who benefits from setting these standards.


Can you discuss a little bit about what the Connections Certification Process is and the theories of Brene Brown?

Brene Brown is a social worker, a researcher and an expert in vulnerability, courage, worthiness, and shame.  She has an amazing ability to language people’s experiences.  You can learn more about her at Brene Brown: Researcher Ÿ• Storyteller


The Connections Certification Process gives facilitators the skills, knowledge, and awareness to understand shame in the lives or our clients.   We are better able to identify how and where it’s showing up in  the lives of our clients and how to work with them to cultivate shame resilience.  Through that work we are able to help them begin to explore the power of love, belonging, and being enough.

The curriculum is based on Brene’s Shame Resilience theory, popularized in her 2006 book I Thought It Was Just Me (but it isn’t): Making the Journey from “What Will People Think?” to “I Am Enough”.


Are these theories and techniques new or are they widely used among therapists?  Are they specific to the treatment of certain behaviors and disorders or are they useful in an overall therapeutic approach?

Shame has been studied and written about by a number of therapists and researchers, however, shame is not taught in most graduate training programs as a part of the core classes.   Brene’s research is based on grounded theory, which is a new means of understanding shame resilience.

The individual and group work that I offer based on the Connections curriculum is especially helpful for people who struggle with perfectionism, feel unworthy, not good enough, or stuck.  Certified Connections Curriculum Facilitators (CCCFs) offer these groups to a wide variety of clients, including people struggling with body image, eating disorders, addictions, and to those with everyday problems.


The word “mindfulness” appears everywhere these days, so much so that it seems like a buzzword.  Can you discuss exactly what it means to be mindful, and lend it some legitimacy for those who may think it overused?

Carl Rogers wrote, ““The curious paradox is that when I accept myself just as I am, then I can change.”  The practice of learning to notice what is happening inside of us with non-judgment and coming to the experience of ourselves and others with self compassion are core aspects of mindfulness.

People are the most critical and judgmental of themselves.  The inner critic or negative self-talk is often shame based and keeps us disconnected from ourselves and the people we care about the most.

When clients are taught to notice what is going on inside of their minds and bodies, rather than react – that is practicing being mindful.  When you give yourself space and time, you see yourself and the world in new way which Carl Rogers described well.


Why is the concept of the “ideal woman” or “ideal life” so stressful?

When we start to consider our ideal identities, often our inner critic reminds us of our unwanted identities around appearance, body image, money, work, motherhood/fatherhood, family, parenting, mental and physical health, including addiction, sex, aging, religion, speaking out, surviving trauma, and being stereotyped and labeled.

The ideal woman and the ideal life are “ideals” that society, media, and culture have created and maintained.  This is not ideal in the sense that you are healthfully striving to be the best you or live your best life; these ideals are unattainable and laden with double binds.

If you do this, be this, wear this, look this way, eat this, or strive for this, you are making one person or group happy and angering or irritating another group.


Who created these “ideals” and who benefits by the repetitive message?

Examining who created these ideals, who perpetuates the ideals, and who benefits from them is a central component of the shame resilience work.  This piece of the work is called raising critical awareness.


What questions should people ask as they begin to look for the right therapeutic fit?

The key to a success in therapy is finding the right match for you.  Some questions to consider are:

  • Did the therapist seem interested in me as a person?
  • Did the therapist seem to understand my concerns?
  • Did I feel listened to and accepted?
  • Did I get a sense of how we would proceed if we chose to work together?
  • Was I able to direct the conversation if I wanted to?
  • Did I feel comfortable asking questions or sharing information?
  • Did I learn new information or gain a new perspective on my problems?
  • Did I like this person?
  • Will I want them in my life for the next (3 months, 6 months, 2 years…)?


What is Shame Resilience Theory?  How is it practiced in therapy?  Is it Talk Therapy or CBT?

According to Brene Brown, shame is a silent epidemic, and the more we keep it secret, the firmer its hold on us. Even helping professionals are hesitant to use the word shame with clients.

Shame is defined as “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of connection and belonging.”

We cannot escape shame; it is an emotion that everyone experiences, however, we can develop resilience to shame. Shame resilience theory teaches that shame resilience can be cultivated by:

  • Recognizing and accepting personal vulnerability.
  • Raising critical awareness regarding social/cultural expectations: Critical awareness surrounding shame is the ability to link how we are personally feeling with society’s sometimes conflicting and shaming expectations of us as individuals. We see the big picture (we contextualize).
  • Forming mutually empathetic relationships that facilitate reaching out to others
  • “Speaking shame,” possessing the language and emotional competence to discuss and deconstruct shame

Trained therapists and coaches are able to use the model with individual and group clients and modify the application based on the therapist or coach’s expertise.  In my practice based, on the client’s needs, I use this model with individuals and groups and blend the theory and Connections model with mindfulness, CBT, dynamic work, and/or art therapy.


Why is shame such a big part of body image?  Can’t women just tune out the magazines in line at the grocery store or tell themselves other people’s expectations don’t matter?

We innately want to belong, feel like we are worthy and know that we are lovable.  Our inner critic and negative self talk can get hooked and even sucker punched in those magazines.  When we can’t see ourselves in those images, it hurts.

This goes back to the double binds of ideal body image and appearance.  The good news is and you can learn to deal with your reactions to magazines and your inner critic.


When dealing with a client who can’t define for herself what healthiness and happiness are, how do you go about helping to define that?  Since it’s such a personal balance, and image and identity conversations are loudest in the mind, what means of positive messaging “sticks best” for your clients in their work with you?

Most clients who come to my office struggle with knowing what their own happiness and healthiness are, rather than defaulting to what their partner, parents, friends, society, media, or inner critic reinforce in them.  The art making process (creating and expressing) can provide a supportive platform to explore what is life giving/affirming to them.  As the art making process often works beyond the talking mind, woman are able to access an inner sense of knowing what words alone could not suggest.

When the client creates something meaningful, I often recommend taking a picture with their smart phone to carry with them throughout the week.  They can pull up the image when they need inspiration, grounding, or reminding of the hard work they are doing and the seeds that they are nurturing within.

We often talk about the reality that it has taken a life time to learn the messages and to learn how to live in a way that is disconnected from oneself and others.  It is a journey to learn to come back to you.


Amy, thank you so much for your time and for the really great information!  It really gives us all a lot to think about.  We’ll be looking forward to your next article!


To contact Amy Tatsumi:

Amy Tatsumi, MA, LPC, ATR-BC
Art Therapist & Psychotherapist
Certified Connections Facilitator- Candidate

Tatsumi & Jones
4707 Connecticut Avenue NW, Suite 103
Washington, DC 20008
(202) 540-0796 (office)

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