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This short, focused book has, as its title suggests, the experience of shame and guilt in the consulting room very much in its sights. I approached the book with great hope. Something about its short, pithy intent blew a breath of fresh air into an area of my practice which can feel long, repetitive, stuck and dispiriting. But I left it
recognising that there is no magical solution to shame and guilt, only slow, hard work, but with the hope that this generous and thoughtful addition to my own thinking might make the process more productive and less draining.
Jan McGregor Hepburn provides as much psychoanalytic theoretical background to these concepts as is needed to understand their genesis and the kinds of internal states they might be symptomatic of, and the reasons why guilt and shame might present such particular difficulties in the consulting room. But the book's primary intent is to offer clinicians different ways to think about the states of persecutory guilt and pathological shame and to offer a number of techniques which Jan McGregor Hepburn has found useful over her 40 years of working with these states. She is at pains to point out that shame and guilt are different in each patient, and that there can be no comprehensive guide to working with them.
The first paragraph of the book sets out the confronting conundrum that while inducing guilt and shame is generally thought to be a useful tool to affect behaviour positively, in fact it tends to backfire and cause anger and resentment which often leads to further bad behaviour. As McGregor Hepburn later points out, it's not the guilt itself that leads to reparation, it's the capacity to think about it, to analyse it and to recognize the meaning and purpose of what has been done, which allows someone to change.
Chapter 2 explores the differences between shame and guilt: how they feel, when they occur developmentally, where they might come from. Guilt relates to what you do, shame to who you are; guilt tends to