ABSTRACT
The author presents three faces of shame: Dysregulated, deficit, and dissociated. All clients who suffer chronic shame have a history of feeling self disintegrating in the presence of dysregulating others. For some, ongoing dysregulation is a primary problem. Their treatment requires solid, fearless, compassionate, containing presence and the ability to help them mentalize fragmented states. For other clients, the experience of self-deficit is the primary problem. Their treatment requires making oneself available for interpersonal connectedness, selfobject transferences, and working through eruptions of in-session shame that accompanies empathic breaks. For a third group, the primary problem is their total dissociation of shame that leads to deep disconnections within their self-experience, an incapacity for vulnerability and genuine empathy, and inauthentic, projective relationships with others. Treatment requires patient’s “large empathy” for their dilemma, nurturing whatever bits of vulnerability appear, and trusting non-linear change processes. In all cases, what matters is the specific intentional quality of therapeutic being-with.
