Shame and Psychotherapy

"Man is the only animal that blushes. Or needs to."

Mark Twain

One of the most striking contradictions that I have come across as a therapist is the discrepancy between the centrality of the affect of shame in humans, and the lack of attention shame has received in the study and practice of psychology. In my own training, I was taught to attend to a wide range of feelings: anger, fear, sexuality, excitement, sadness, but rarely, if ever, the feeling of shame. Shame is also avoided in the "real" world as well. In fact, most of us feel shame about feeling shame. As a result shame is rarely acknowledged to others, or even to oneself. In the last five years I have been paying much more attention to shame in working with my clients, and am amazed at how crucial attending to this feeling is to doing psychotherapy. As with any feeling, when shame is denied it will only resurface to create even more pain and havoc.

Unfortunately, shame is often unbearable. For example humiliation and mortification, which are part of the "shame family of feelings" may be so painful they may lead to violence or suicide. We may equate shame with being worthless, unlovable, unredeemable, or cut-off from humanity. It may evoke other painful feelings, rage at the one we feel shamed by, or terror that we will be abandoned, fragmented and/or overwhelmed with despair. Silvan Tomkins (in Nathanson, 1992) said:

If distress is the affect of suffering, shame is the affect of indignity, transgression and of alienation. Though terror speaks to life and death and distress makes of the world a vale of tears, yet shame strikes deepest into the heart of man.... shame is felt as inner torment, a sickness of the soul....the humiliated one feels himself naked, defeated, alienated, lacking in dignity and worth.

Helen B. Lewis, a pioneer in recognizing the importance of shame to psychotherapy, argued that shame really represents an entire family of emotions. This family includes: humiliation, embarrassment, feelings of low self-esteem, belittlement, and stigmatization. Shame is often a central ingredient in experiences of being:




Shame manifests itself physically in a wide variety of forms. The person may hide their eyes; lower their gaze; blush; bite their lips or tongue; present a forced smile; or fidget. Other responses may include annoyance, defensiveness, exaggeration or denial. Because the affect of shame often interferes with our ability to think, the individual may experience confusion, being at a loss for words, or a completely blank mind.

Shame is often experienced as the inner, critical voice that judges whatever we do as wrong, inferior, or worthless. Often this inner critical voice is repeating what was said to us by our parents, relatives, teachers and peers. We may have been told that we were naughty, selfish, ugly, stupid, etc. We may have been ostracized by peers at school, humiliated by teachers, treated with contempt by our parents. Paradoxically, shame may be caused by others expecting too much of us, evoking criticism when our performance is less than perfect. Some authority figures are never satisfied with one's efforts or performance, they are critical no matter what. Unfortunately, these criticisms become internalized, so that it is our own inner critical voice that is meting out the shaming messages, such as: "You idiot, why did you do that?," "Can't you do anything right?,"or " You should be ashamed of yourself," etc.

One source of shame is associated with the expression of certain emotions. In many families, as well as in many cultures, expression of such feelings as anger, fear, sadness or vulnerability, may be met with shaming reproaches, such as "Pull yourself together," "Don't be a baby," "Stop crying or I'll give you something to cry about," or "You don't have anything to be afraid of." Pride is also a feeling that is often met with shameful condemnations, such as "Who do you think you are, Mr. Bigshot?," or "You're getting too big for your britches." Often these shaming admonitions are internalized, so that when we get in touch with any of these "shameful feelings" we will automatically feel shame, and try to control or hide the feelings, or, at the very least, to apologize profusely for them.

Clearly these shaming inner voices can do considerable damage to our self esteem. These self criticisms, that we are stupid, selfish, a show-off, etc., become, in varying degrees, how we see ourselves. For some of us, the inner critical judge is continuously providing a negative evaluation of what we are doing, moment-by-moment. As mentioned before, the inner critic may make it impossible for one to do anything right, telling you that you are too aggressive, or not aggressive enough, that you're too selfish, or that you let people walk all over you.

Shame And Couples

Additionally shame is often at the root of marital discord. For example, if one member of the couple wants more intimacy, and/or communication than the other, both may feel shame as a result. The one wanting more intimacy may feel rejected and shamed for wanting too much, the other may feel shame for either not being comfortable with more closeness, or for wanting more distance than the other. The shame, because it is so painful, is often bypassed, and can turn into blaming each other (“You don’t love me!”, or “You’re too needy!”). Unfortunately this results in an increase in shame for both people, resulting in an escalation of blame, a vicious cycle that can have devastating results. In my work with couples, I focus on what each member of the relationship wants, or does not want, and to frame it in a way that minimizes both people’s shame and blame. Instead there can be the conversation that was prevented by the shame/blame cycle, decreasing hostile interactions and increasing an understanding of what the other wants.

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In this brief synopsis, I tried to describe some of the ideas about shame that have had a significant effect on my work as a psychotherapist, with both individuals and couples. Shame plays a major role in everyone's life. Yet, this often excruciatingly painful feeling, in its various disguises, has, for the most part, been overlooked by most psychotherapies. Our insensitivity to this issue has, I feel, been a major barrier to people being able to make full use of what psychotherapy has to offer.

Please feel free to call me at (510) 528-4441 or e-mail me at Marc Miller, PhD to discus if I can be of help to you. I look forward to hearing from you.


Lewis, H. B. 1971. Shame and guilt in neurosis. International University Press. New York.

Nathanson, D., ed. (1987) The Many Faces of Shame. The Guildford Press: New York.