Case examples can help us explore the role shame can playin allowing a person to maintain a psychological organiza-tion the individual experiences as necessary for survival. Painful adult shame experience is not always correlated with excess childhood shaming, as Wurmser (1981) notes (p. 63), but is probably correlated with a surfeit of childhood pain and helplessness. The pain that is managed through the pursuit of adult shame may be childhood shame, but more likely it is a complex of interrelated emotions. This observation has important treatment consequences to be explored later. Here, suffice it to say that I think it a mistake to assume that treatment for those presenting with painful adult shame always should center on specific shame memories from childhood, as is implied in the work of some writers. David Shapiro's (1965, 1981) work on character formation does a fine job demonstrating how adult character stances can generate affect. As one such character formation, masochism of varying types and intensities can be thought of as a set of structures by means of which varieties of helplessness are managed through perpetuation of painful relationships with others, as well as through painful self-reflection.