by:  MARK MCKINLEY, PSY.D.

SHAME IN THE THERAPEUTIC RELATIONSHIP

The experience of shame is universal. As social creatures, humans desire connection and a sense of belonging. Each social group one belongs to has established, often implicitly, certain standards of behavior or ways of being that are deemed acceptable. Transgressing these moral codes of appropriateness threatens expulsion from or censure by the group. The desire to be accepted by others opens one towards the possibility of disconnection. This inherent vulnerability in relating to others fuels the potential for shame.

The word "shame" can be traced back to the proto-Indo-European word kem, which means "to cover." We experience shame as a particular kind of covering over of those aspects of ourselves that are perceived to be inferior, unworthy, or morally unacceptable. The power of shame rests in the threat of social disconnection if others discover these perceived flawed parts of one's self. Shame therefore functions to protect these vulnerable aspects from exposure, and its mobilization collapses the possibility of exploring its underlying secret.

Shame in the context of psychotherapy is often associated with profound events that occurred in the patient's life, such as surviving a trauma or battling an addiction. These experiences certainly contribute to the transference relationship; however, an element of shame that seems to go unnoticed involves the ways in which shame operates in the "real" relationship. For example, when a therapist consistently does not take seriously the concrete concerns a patient presents in favor of interpreting their transference implications, this emphasis may have the effect of communicating that such concerns are unworthy of discussion. Feeling dismissed yet desiring to be accepted by the therapist, the patient may capitulate to this interpersonal demand and cover over those aspects of his or her experience. This subtle way of shaming sculpts the intersubjective field and truncates the possibilities of what can be revealed in the therapeutic process.

The privileging of certain material is an inherent characteristic of psychotherapy. However, not being cognizant of ways our actions as therapists may elicit the patient's shame can cause undue harm. Staying alert to the possibility of shame operating within the "real" relationship can sensitize therapists to explore why certain aspects of the patient's experience remain covered over. In this context, resistance may reflect shame induced by the therapeutic relationship as opposed to a purely intrapsychic conflict. Making such distinctions is critical in determining how the therapist proceeds technically.

Mark McKinley, Psy.D.
Impulse Staff Writer