04/11/2025
: An Occupational Therapist’s Perspective on Childhood Shame
As therapists, we witness daily how childhood shame becomes embedded in the nervous system. When a child becomes overwhelmed in our office, we’re not seeing their authentic self—we’re observing their protective response to internal distress.
In my practice, I’ve found that children carry the weight of labels assigned to them: “difficult,” “sensitive,” “stubborn.” These given indentities follow them like shadows, influencing how they see themselves and how others respond to them.
Therapeutic presence means recognizing that a child’s dysregulation isn’t personal, permanent, or defining. It’s a momentary state reflecting their internal experience—often one of shame, fear, or overwhelm.
When we respond with curiosity rather than judgment, with connection rather than consequence, we create neurological pathways that teach children their worth exists independently of their behavior. And it unlocks their capacities for doing the things they want and need to do in daily life. For OTPs, we have to start with the regulation, before we can start with the doing.
How children (and adults!) act isn’t who they are.
The most transformative moments in therapy occur when a child realizes they won’t be held hostage to their past actions—that each session offers a fresh opportunity to be seen for who they truly are beneath the protective armor.
Our role as clinicians isn’t just to address the “behavior” but to help children reconnect with their authentic selves—the creative, joyful, resilient beings that shame has taught to hide.
In this sacred work, we become the responsive caregivers who demonstrate that healing begins when we separate the doing from the being.