‘Am I a Ceadas child?’: exploring the nature and experience of shame in the psychotherapy of an adolescent boy

Although shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.