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Shame-Related States of Mind in Psychotherapy

Received July 1, 1997; accepted October 9, 1997. From the University of California–San Francisco School of Medicine and San Francisco Department of Veterans Affairs Medical Center. Address correspondence to Dr. Zaslav, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.

Current theory on self-conscious emotions emphasizes the importance of shame-related phenomena in psychopathology and psycho- therapy. An appreciation of manifestations of shame in psychotherapy greatly deepens our ability to connect with and understand our patients' experience. The relative salience of the shame-prone patient's devalued-self or devaluing-other internalizations will have critical importance in the psychotherapy setting, guiding the types of interventions and stances that are most helpful. Knowledge of some predictable shame-related transactions involving envy, blaming, or overzealous probing can help the psychotherapist preempt mobilization of unnecessary levels of shame in treatment.