Psychotherapy Volume 37/Spring 2000/Number 1 SHAME: COUNTERTRANSFERENCE IDENTIFICATIONS IN INDIVIDUAL PSYCHOTHERAPY

Shame is a universal experience felt by patients and therapists alike. Yet, the experience of shame, with its profound sense of inadequacy and worthlessness, is anathema to the competent and compassionate self-image of most therapists. In order to help therapists understand their own shame and their countertransference identifications to patient shame, this article first describes the nature of shame, its developmental progression within interpersonal relationships, and the defenses commonly employed to cope with shame. Because the experience of shame involves the activation of devalued and devaluing internal representations, therapists may develop concordant or complementary countertransference identifications. These countertransference identifications are influenced further by the patient's primary reaction to shame, which includes withdrawal, attacks on self, avoidance, and attacks on others. Each of these reflects a habitual reaction to shame that is displayed in the patient-therapist relationship