The less mindful therapists out there may look at a client who didn't quite perform up to par and simply utilize that shame as a lesson-learned to push that client into further adherence. How far does this shame help an individual's motivation, though?
Quite a ways back, I wrote about health-shaming with the assistance of a sports behavioural consultant. With the example of guilt in relation to diet, it was shown that higher levels of guilt were associated with a poor perception of control and decreased rate of success when it came to changing a behaviour.
In short, the more guilty a person feels about poor progress when trying to change, whether it's with diet, fitness, or pain-control, the lower rate of success to make that change!
From a personal standpoint, I've experienced this with clients who simply "fall off the wagon" and relapse in their pain and health. Regardless of whether it was their own doing (ie: poor exercise adherence) or not (time barriers or accidents), this sense of guilt has resulted in a lack of drive to continue forward.
As far as I'm concerned, if a client feels guilty, then the onus is on myself just as much as it is on them. It's my job, as the therapist, to create and enforce realistic expectations with a client's habits that they are happy with as well as to help them plan for any contingencies or relapses. Clients of any type of medical practitioners must not feel like they aren't "being good" and can't face the person who is working to help them. If any professional is making you feel bad about your performance, you may be developing a toxic relationship.
So to any individuals out there who are in pain, please don't feel guilty.
To the clinicians, stop making your clients feel guilty!