Shame is a universal affect that everyone would like to avoid. Responses to trauma include profound experiences of shame, which re-emerge in the transference and can be recognized in reciprocal countertransference responses. Primitive defense mechanisms associated with borderline states such as projection, projective identification and splitting, are often encountered during the course of intensive psychotherapies involving traumatic shame. Attempts to avoid shame reactions may involve regressive reactions, even in non-borderline individuals. Shame avoidance may produce transference-countertransference enactments leading to a negative therapeutic reaction. Addressing shame-related issues may be difficult for both therapist and patient, but ultimately are essential for productive therapy and recovery from trauma.