Shame in Psychotherapy with Adolescents

Shame has been an insufficiently studied emotion in psychoanalytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.