Working with shame in psychodynamically oriented psychotherapy

Abstract

Shame is the most often experienced affect by patients in therapy. But because shame is mainly uncon­scious and unrecognized it is often neglected in psychotherapy. It is therefore recommended that the psychotherapist pays attention to verbal and nonverbal manifestations of shame in the patient and in himself and does not avoid the topic of shame. With shame-prone individuals it is important to establish a good therapeutic working alliance and an atmosphere of trust, safety and acceptance, since this is the best way to get closer to the painful feelings of shame. The psychotherapist must notice the patients’ defence reactions to shame and reveal them gradually and with tact. He should monitor his own countertransference feelings, because they can be especially intensive when working with shame.