Clinical psychoanalysis has ignored shame as the source of psychopathology, despite a burgeoning literature. Here the authors present an analysis carried out with a hospitalized child diagnosed as borderline. The analyst's efforts to interpret the patient's self-concealing behaviors elicited intensified shame reactions not clearly understood at the time. Here the authors explore the evolutionary and developmental origins of shame as a primary affect modifying the interest the organism has in novel stimuli. The authors briefly explain why clinicians overlook the relationship of shame to both psychopathology and psychoanalytic technique. In this case, the illness, based largely on the child's chronic experience of humiliation, remitted in response to the supportive influence of an extraordinarily sensitive hospital setting combined with the analyst's growing willingness to accept the child's positive response to being accepted on his own grounds. These laid the foundation for a psychoanalytic process to take place.