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Working with shame in psychoanalytic treatment
Journal of the American Psychoanalytic Association
|January 1, 1984
Summary
Shame is central to psychoanalytic treatment, particularly in narcissistic pathology. This study articulates a systematic approach to recognizing, accepting, and investigating shame in patients for effective therapeutic outcomes.
Area of Science:
- Psychology
- Psychoanalysis
- Psychotherapy
Background:
- Shame, an affect reflecting self-defects, is integral to psychoanalytic theory.
- Freud's work on narcissism and the ego ideal laid groundwork for shame study.
- Later contributions by Hartmann, Reich, Sandler, Schafer, and Kohut furthered understanding of the ego ideal, ideal self, and self-pathology.
Observation:
- Shame is central to narcissistic pathology, manifesting as pervasive internal shaming.
- In neurotic patients, shame is more limited, linked to partial self-failures and castration fears.
- Clinical examples illustrate therapeutic sequences for addressing shame in both patient types.
Findings:
- A systematic approach to shame in psychoanalytic treatment involves recognition, acknowledgment, acceptance, and investigation.
- Empathic investigation of shame is crucial before exploring underlying conflicts.
- Shame's role in psychoanalytic treatment is systematically articulated.
Implications:
- Understanding and addressing shame is key to effective psychoanalytic treatment, especially for narcissistic disorders.
- A structured approach to shame can enhance therapeutic outcomes.
- This work provides a framework for clinicians to systematically work with shame in psychoanalysis.